Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $137.16 / $573.12 / $1,212.22	Facility		$137.16	$573.12	$1,212.22
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.80 / $24.69 / $27.56	Facility	26	$23.80	$24.69	$27.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.68 / $178.25 / $649.00	Professional		$120.68	$178.25	$649.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.84 / $23.28 / $60.72	Professional	26	$19.84	$23.28	$60.72
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.67 / $65.36 / $110.11	Professional	52	$60.67	$65.36	$110.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.50 / $157.09 / $324.83	Professional	TC	$101.50	$157.09	$324.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $147.66 / $164.07 / $210.01	Professional		$147.66	$164.07	$210.01
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $20.11 / $22.35 / $32.63	Professional	26	$20.11	$22.35	$32.63
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $127.55 / $141.72 / $181.40	Professional	TC	$127.55	$141.72	$181.40
Cigna Facility/Professional Facility Modifier Low / Median / High Price $157.49 / $157.49 / $157.49	Facility		$157.49	$157.49	$157.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.52 / $187.56 / $291.02	Professional		$125.52	$187.56	$291.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.82 / $29.19 / $47.37	Professional	26	$19.82	$29.19	$47.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $106.13 / $166.82 / $246.90	Professional	TC	$106.13	$166.82	$246.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $135.40 / $174.67 / $240.70	Professional		$135.40	$174.67	$240.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.50 / $27.31 / $43.42	Professional	26	$21.50	$27.31	$43.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $113.90 / $146.93 / $204.90	Professional	TC	$113.90	$146.93	$204.90
United Facility/Professional Professional Modifier Low / Median / High Price $122.18 / $172.04 / $276.23	Professional		$122.18	$172.04	$276.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.59 / $25.07 / $45.89	Professional	26	$17.59	$25.07	$45.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.45 / $147.81 / $245.11	Professional	TC	$98.45	$147.81	$245.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $135.40 / $155.71 / $192.35	Professional		$135.40	$155.71	$192.35
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $21.50 / $24.72 / $30.87	Professional	26	$21.50	$24.72	$30.87
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $113.90 / $130.97 / $163.37	Professional	TC	$113.90	$130.97	$163.37