Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $157.47 / $389.24 / $671.78	Facility		$157.47	$389.24	$671.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.24 / $45.06 / $45.16	Facility	26	$37.24	$45.06	$45.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $143.05 / $179.02 / $358.64	Professional		$143.05	$179.02	$358.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.24 / $49.69 / $124.83	Professional	26	$37.24	$49.69	$124.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $128.19 / $178.89 / $192.89	Professional	52	$128.19	$178.89	$192.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $105.23 / $130.24 / $189.52	Professional	TC	$105.23	$130.24	$189.52
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $170.08 / $185.48 / $231.85	Professional		$170.08	$185.48	$231.85
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $43.52 / $48.35 / $56.61	Professional	26	$43.52	$48.35	$56.61
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $123.42 / $137.13 / $157.69	Professional	TC	$123.42	$137.13	$157.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.68 / $238.73 / $422.82	Professional		$117.68	$238.73	$422.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.11 / $65.55 / $112.42	Professional	26	$34.11	$65.55	$112.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.12 / $171.72 / $314.49	Professional	TC	$83.12	$171.72	$314.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $99.77 / $147.58 / $213.34	Professional		$99.77	$147.58	$213.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.05 / $42.60 / $58.10	Professional	26	$29.05	$42.60	$58.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.73 / $106.17 / $156.40	Professional	TC	$70.73	$106.17	$156.40
United Facility/Professional Professional Modifier Low / Median / High Price $146.50 / $212.41 / $413.76	Professional		$146.50	$212.41	$413.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.09 / $53.93 / $103.44	Professional	26	$35.09	$53.93	$103.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.71 / $156.38 / $298.20	Professional	TC	$110.71	$156.38	$298.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $133.03 / $151.62 / $189.52	Professional		$133.03	$151.62	$189.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.72 / $44.54 / $56.46	Professional	26	$38.72	$44.54	$56.46
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $94.30 / $106.45 / $133.07	Professional	TC	$94.30	$106.45	$133.07