Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $125.89 / $151.36	Facility	26	$75.86	$125.89	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $338.84 / $1,318.26	Professional		$69.18	$338.84	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $131.83 / $354.81	Professional	26	$63.10	$131.83	$354.81
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $251.19 / $309.03 / $1,096.48	Professional	50	$251.19	$309.03	$1,096.48
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $31.62 / $173.78 / $1,023.29	Professional	52	$31.62	$173.78	$1,023.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $338.84 / $933.25	Professional	TC	$154.88	$338.84	$933.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $269.15 / $436.52	Professional		$79.43	$269.15	$436.52
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $87.10 / $112.20	Professional	26	$74.13	$87.10	$112.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $213.80 / $602.56	Professional	TC	$190.55	$213.80	$602.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $104.71 / $104.71	Facility	26	$104.71	$104.71	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $371.54 / $676.08	Professional		$177.83	$371.54	$676.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $74.13 / $144.54	Professional	26	$50.12	$74.13	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $257.04 / $549.54	Professional	TC	$125.89	$257.04	$549.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $245.47 / $467.74	Professional		$213.80	$245.47	$467.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $72.44 / $97.72	Professional	26	$63.10	$72.44	$97.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $173.78 / $354.81	Professional	TC	$151.36	$173.78	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $302.00 / $645.65	Professional		$199.53	$302.00	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $69.18 / $117.49	Professional	26	$38.02	$69.18	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $218.78 / $537.03	Professional	TC	$144.54	$218.78	$537.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $251.19 / $338.84	Professional		$213.80	$251.19	$338.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $75.86 / $97.72	Professional	26	$64.57	$75.86	$97.72
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $173.78 / $239.88	Professional	TC	$147.91	$173.78	$239.88