Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.59 / $38.49 / $40.61	Facility	26	$28.59	$38.49	$40.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.82 / $160.76 / $396.00	Professional		$106.82	$160.76	$396.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.65 / $54.15 / $127.88	Professional	26	$29.65	$54.15	$127.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $50.14 / $57.94 / $161.51	Professional	52	$50.14	$57.94	$161.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.23 / $99.67 / $231.82	Professional	TC	$78.23	$99.67	$231.82
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $118.27 / $139.80 / $177.55	Professional		$118.27	$139.80	$177.55
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $32.75 / $36.39 / $50.76	Professional	26	$32.75	$36.39	$50.76
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $87.49 / $103.41 / $131.33	Professional	TC	$87.49	$103.41	$131.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.71 / $128.85 / $264.04	Professional		$87.71	$128.85	$264.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.28 / $39.70 / $72.78	Professional	26	$25.28	$39.70	$72.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.43 / $91.62 / $194.24	Professional	TC	$65.43	$91.62	$194.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $122.17 / $153.01 / $218.36	Professional		$122.17	$153.01	$218.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.01 / $41.38 / $58.80	Professional	26	$33.01	$41.38	$58.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.07 / $108.13 / $164.08	Professional	TC	$89.07	$108.13	$164.08
United Facility/Professional Professional Modifier Low / Median / High Price $88.04 / $122.14 / $287.16	Professional		$88.04	$122.14	$287.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.41 / $33.14 / $63.05	Professional	26	$26.41	$33.14	$63.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.00 / $89.86 / $168.68	Professional	TC	$64.00	$89.86	$168.68
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $98.06 / $140.50 / $173.77	Professional		$98.06	$140.50	$173.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.56 / $38.07 / $48.12	Professional	26	$26.56	$38.07	$48.12
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $71.50 / $102.43 / $127.79	Professional	TC	$71.50	$102.43	$127.79