Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.01 / $126.00 / $250.74	Facility	26	$75.01	$126.00	$250.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.22 / $425.00 / $1,160.76	Professional		$178.22	$425.00	$1,160.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.73 / $126.31 / $320.91	Professional	26	$67.73	$126.31	$320.91
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $970.19 / $970.19 / $1,065.47	Professional	50	$970.19	$970.19	$1,065.47
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.69 / $212.50 / $580.38	Professional	52	$123.69	$212.50	$580.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $176.33 / $335.00 / $942.38	Professional	TC	$176.33	$335.00	$942.38
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $303.81 / $337.57 / $441.63	Professional		$303.81	$337.57	$441.63
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $68.97 / $74.52 / $97.51	Professional	26	$68.97	$74.52	$97.51
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $237.02 / $263.36 / $346.05	Professional	TC	$237.02	$263.36	$346.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.39 / $384.97 / $679.35	Professional		$181.39	$384.97	$679.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $75.78 / $149.31	Professional	26	$49.90	$75.78	$149.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.13 / $274.91 / $554.39	Professional	TC	$129.13	$274.91	$554.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.98 / $276.02 / $487.60	Professional		$213.98	$276.02	$487.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.64 / $77.42 / $105.71	Professional	26	$63.64	$77.42	$105.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $149.47 / $192.82 / $381.07	Professional	TC	$149.47	$192.82	$381.07
United Facility/Professional Professional Modifier Low / Median / High Price $194.41 / $291.61 / $629.37	Professional		$194.41	$291.61	$629.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.63 / $65.66 / $108.56	Professional	26	$33.63	$65.66	$108.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.01 / $218.81 / $545.99	Professional	TC	$143.01	$218.81	$545.99
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $171.18 / $232.70 / $302.51	Professional		$171.18	$232.70	$302.51
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.62 / $67.70 / $88.01	Professional	26	$51.62	$67.70	$88.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $119.58 / $165.00 / $210.93	Professional	TC	$119.58	$165.00	$210.93