Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $102.33 / $302.00	Facility	26	$40.74	$102.33	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $165.96 / $436.52	Professional		$131.83	$165.96	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $46.77 / $123.03	Professional	26	$36.31	$46.77	$123.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $30.20	Professional	52	$30.20	$30.20	$30.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $114.82 / $295.12	Professional	TC	$93.33	$114.82	$295.12
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $165.96 / $407.38	Professional		$44.67	$165.96	$407.38
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $50.12 / $53.70	Professional	26	$44.67	$50.12	$53.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $128.82 / $141.25	Professional	TC	$114.82	$128.82	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $204.17 / $446.68	Professional		$144.54	$204.17	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $56.23 / $125.89	Professional	26	$39.81	$56.23	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $147.91 / $316.23	Professional	TC	$102.33	$147.91	$316.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $181.97 / $371.54	Professional		$165.96	$181.97	$371.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $50.12 / $104.71	Professional	26	$47.86	$50.12	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $128.82 / $269.15	Professional	TC	$117.49	$128.82	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $208.93 / $562.34	Professional		$141.25	$208.93	$562.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $60.26 / $154.88	Professional	26	$39.81	$60.26	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $151.36 / $407.38	Professional	TC	$104.71	$151.36	$407.38