Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.65 / $95.63 / $252.75	Facility	26	$29.65	$95.63	$252.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $108.01 / $115.88 / $199.87	Professional		$108.01	$115.88	$199.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.65 / $30.85 / $71.75	Professional	26	$29.65	$30.85	$71.75
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $53.41 / $57.94 / $62.80	Professional	52	$53.41	$57.94	$62.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.65 / $86.23 / $147.24	Professional	TC	$79.65	$86.23	$147.24
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $139.80 / $139.80 / $272.43	Professional		$139.80	$139.80	$272.43
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $36.39 / $36.39 / $76.87	Professional	26	$36.39	$36.39	$76.87
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $93.07 / $103.41 / $136.60	Professional	TC	$93.07	$103.41	$136.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.50 / $151.59 / $373.41	Professional		$94.50	$151.59	$373.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.80 / $39.60 / $102.30	Professional	26	$27.80	$39.60	$102.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.94 / $101.94 / $271.11	Professional	TC	$65.94	$101.94	$271.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $122.17 / $146.36 / $282.36	Professional		$122.17	$146.36	$282.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.10 / $38.22 / $71.88	Professional	26	$33.10	$38.22	$71.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.07 / $108.13 / $210.49	Professional	TC	$89.07	$108.13	$210.49
United Facility/Professional Professional Modifier Low / Median / High Price $98.20 / $135.71 / $388.68	Professional		$98.20	$135.71	$388.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.45 / $35.36 / $98.94	Professional	26	$26.45	$35.36	$98.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.79 / $89.86 / $289.74	Professional	TC	$71.79	$89.86	$289.74