Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $37.15 / $42.66	Facility	26	$30.90	$37.15	$42.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $218.78 / $562.34	Professional		$112.20	$218.78	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $60.26 / $134.90	Professional	26	$33.88	$60.26	$134.90
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $58.88 / $562.34	Professional	52	$30.20	$58.88	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $128.82 / $363.08	Professional	TC	$81.28	$128.82	$363.08
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $131.83 / $165.96	Professional		$107.15	$131.83	$165.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $38.02 / $39.81	Professional	26	$33.88	$38.02	$39.81
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $134.90	Professional	TC	$95.50	$95.50	$134.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $58.88 / $58.88	Facility	26	$58.88	$58.88	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $154.88 / $288.40	Professional		$102.33	$154.88	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $41.69 / $81.28	Professional	26	$28.18	$41.69	$81.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $112.20 / $213.80	Professional	TC	$74.13	$112.20	$213.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $147.91 / $199.53	Professional		$134.90	$147.91	$199.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $39.81 / $54.95	Professional	26	$35.48	$39.81	$54.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $107.15 / $147.91	Professional	TC	$97.72	$107.15	$147.91
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $154.88 / $245.47	Professional		$112.20	$154.88	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $41.69 / $64.57	Professional	26	$28.84	$41.69	$64.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $112.20 / $177.83	Professional	TC	$83.18	$112.20	$177.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $154.88 / $208.93	Professional		$109.65	$154.88	$208.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $41.69 / $54.95	Professional	26	$29.51	$41.69	$54.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $112.20 / $154.88	Professional	TC	$79.43	$112.20	$154.88