Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.16 / $37.39 / $42.40	Facility	26	$31.16	$37.39	$42.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.86 / $157.13 / $570.48	Professional		$113.86	$157.13	$570.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.31 / $41.52 / $154.22	Professional	26	$32.31	$41.52	$154.22
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $40.02 / $142.94 / $726.00	Professional	52	$40.02	$142.94	$726.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.71 / $98.52 / $260.25	Professional	TC	$82.71	$98.52	$260.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $146.87 / $146.87 / $180.99	Professional		$146.87	$146.87	$180.99
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.21 / $40.21 / $45.96	Professional	26	$40.21	$40.21	$45.96
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $106.66 / $106.66 / $131.74	Professional	TC	$106.66	$106.66	$131.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.03 / $157.22 / $299.20	Professional		$103.03	$157.22	$299.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.15 / $42.82 / $83.61	Professional	26	$28.15	$42.82	$83.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.77 / $118.07 / $217.76	Professional	TC	$74.77	$118.07	$217.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $132.68 / $159.60 / $230.69	Professional		$132.68	$159.60	$230.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.99 / $42.12 / $59.82	Professional	26	$35.99	$42.12	$59.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $96.12 / $115.99 / $170.86	Professional	TC	$96.12	$115.99	$170.86
United Facility/Professional Professional Modifier Low / Median / High Price $113.85 / $151.10 / $234.96	Professional		$113.85	$151.10	$234.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.82 / $39.93 / $67.40	Professional	26	$28.82	$39.93	$67.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.98 / $101.54 / $177.65	Professional	TC	$79.98	$101.54	$177.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $106.56 / $145.09 / $189.54	Professional		$106.56	$145.09	$189.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.22 / $38.86 / $53.01	Professional	26	$29.22	$38.86	$53.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $77.33 / $106.80 / $136.53	Professional	TC	$77.33	$106.80	$136.53