Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $97.72 / $208.93	Facility	26	$28.84	$97.72	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $173.78 / $346.74	Professional		$97.72	$173.78	$346.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $61.66 / $104.71	Professional	26	$28.18	$61.66	$104.71
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $56.23 / $74.13 / $97.72	Professional	52	$56.23	$74.13	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $100.00 / $288.40	Professional	TC	$70.79	$100.00	$288.40
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $131.83 / $363.08	Professional		$95.50	$131.83	$363.08
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $34.67 / $79.43	Professional	26	$31.62	$34.67	$79.43
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $97.72 / $131.83	Professional	TC	$89.13	$97.72	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $128.82 / $288.40	Professional		$95.50	$128.82	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $38.02 / $75.86	Professional	26	$25.70	$38.02	$75.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $89.13 / $177.83	Professional	TC	$61.66	$89.13	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $134.90 / $281.84	Professional		$125.89	$134.90	$281.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $35.48 / $72.44	Professional	26	$33.88	$35.48	$72.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $100.00 / $208.93	Professional	TC	$91.20	$100.00	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $120.23 / $363.08	Professional		$104.71	$120.23	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $34.67 / $93.33	Professional	26	$28.18	$34.67	$93.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $89.13 / $269.15	Professional	TC	$75.86	$89.13	$269.15