Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.40 / $50.42 / $54.70	Facility	26	$48.40	$50.42	$54.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.01 / $134.33 / $417.43	Professional		$89.01	$134.33	$417.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.34 / $54.55 / $193.70	Professional	26	$40.34	$54.55	$193.70
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.74 / $49.24 / $116.41	Professional	52	$43.74	$49.24	$116.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.82 / $75.11 / $148.60	Professional	TC	$46.82	$75.11	$148.60
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $118.88 / $131.69 / $207.61	Professional		$118.88	$131.69	$207.61
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $51.68 / $59.80 / $74.75	Professional	26	$51.68	$59.80	$74.75
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $67.20 / $71.90 / $140.94	Professional	TC	$67.20	$71.90	$140.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.82 / $196.92 / $313.81	Professional		$85.82	$196.92	$313.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.35 / $73.16 / $128.19	Professional	26	$38.35	$73.16	$128.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.19 / $113.29 / $201.71	Professional	TC	$47.19	$113.29	$201.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.29 / $112.29 / $173.04	Professional		$74.29	$112.29	$173.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.60 / $47.93 / $71.84	Professional	26	$32.60	$47.93	$71.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $63.93 / $101.20	Professional	TC	$41.69	$63.93	$101.20
United Facility/Professional Professional Modifier Low / Median / High Price $102.72 / $167.67 / $278.18	Professional		$102.72	$167.67	$278.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.79 / $61.49 / $107.63	Professional	26	$38.79	$61.49	$107.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.93 / $109.94 / $177.45	Professional	TC	$63.93	$109.94	$177.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $99.05 / $113.35 / $141.69	Professional		$99.05	$113.35	$141.69
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $43.46 / $49.98 / $63.35	Professional	26	$43.46	$49.98	$63.35
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $55.59 / $62.68 / $78.34	Professional	TC	$55.59	$62.68	$78.34