Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $48.98 / $1,071.52	Facility	26	$40.74	$48.98	$1,071.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $245.47 / $724.44	Professional		$131.83	$245.47	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $64.57 / $144.54	Professional	26	$42.66	$64.57	$144.54
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 $97.72 / $141.25 / $380.19	Professional	TC	$97.72	$141.25	$380.19
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $162.18 / $194.98	Professional		$44.67	$162.18	$194.98
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $50.12 / $54.95	Professional	26	$44.67	$50.12	$54.95
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $128.82 / $151.36	Professional	TC	$114.82	$128.82	$151.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $75.86 / $75.86	Facility	26	$75.86	$75.86	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $190.55 / $354.81	Professional		$125.89	$190.55	$354.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $53.70 / $104.71	Professional	26	$36.31	$53.70	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $138.04 / $263.03	Professional	TC	$91.20	$138.04	$263.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $181.97 / $251.19	Professional		$165.96	$181.97	$251.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $52.48 / $72.44	Professional	26	$47.86	$52.48	$72.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $131.83 / $181.97	Professional	TC	$117.49	$131.83	$181.97
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $190.55 / $302.00	Professional		$141.25	$190.55	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $53.70 / $83.18	Professional	26	$38.02	$53.70	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $134.90 / $213.80	Professional	TC	$100.00	$134.90	$213.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $190.55 / $257.04	Professional		$134.90	$190.55	$257.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $54.95 / $70.79	Professional	26	$38.90	$54.95	$70.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $138.04 / $186.21	Professional	TC	$95.50	$138.04	$186.21