Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $129.94 / $765.48 / $988.80	Facility		$129.94	$765.48	$988.80
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $66.05 / $66.05 / $66.05	Facility	TC	$66.05	$66.05	$66.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.86 / $82.23 / $687.96	Professional		$53.86	$82.23	$687.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.25 / $57.00 / $393.43	Professional	26	$23.25	$57.00	$393.43
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $26.93 / $31.21 / $70.83	Professional	52	$26.93	$31.21	$70.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $39.83 / $190.70	Professional	TC	$24.44	$39.83	$190.70
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $66.30 / $71.44 / $162.87	Professional		$66.30	$71.44	$162.87
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $41.49 / $41.49 / $90.57	Professional	26	$41.49	$41.49	$90.57
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $20.49 / $29.95 / $39.36	Professional	TC	$20.49	$29.95	$39.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $0.80 / $42.63 / $135.21	Professional		$0.80	$42.63	$135.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.63 / $20.03 / $59.49	Professional	26	$15.63	$20.03	$59.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.29 / $20.72 / $76.69	Professional	TC	$15.29	$20.72	$76.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $73.70 / $88.45 / $119.68	Professional		$73.70	$88.45	$119.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.33 / $44.11 / $79.83	Professional	26	$36.33	$44.11	$79.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $37.39 / $45.38 / $68.45	Professional	TC	$37.39	$45.38	$68.45
United Facility/Professional Professional Modifier Low / Median / High Price $49.58 / $72.00 / $137.71	Professional		$49.58	$72.00	$137.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.80 / $31.17 / $72.33	Professional	26	$23.80	$31.17	$72.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.54 / $35.25 / $81.06	Professional	TC	$23.54	$35.25	$81.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $67.05 / $91.55 / $105.80	Professional		$67.05	$91.55	$105.80
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.09 / $44.11 / $53.07	Professional	26	$37.09	$44.11	$53.07
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $29.97 / $47.44 / $53.63	Professional	TC	$29.97	$47.44	$53.63