Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.45 / $135.56 / $147.16	Facility	26	$108.45	$135.56	$147.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $568.95 / $668.73 / $1,252.22	Professional		$568.95	$668.73	$1,252.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.42 / $131.91 / $450.00	Professional	26	$107.42	$131.91	$450.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $277.83 / $304.37 / $436.24	Professional	52	$277.83	$304.37	$436.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $451.82 / $533.44 / $960.19	Professional	TC	$451.82	$533.44	$960.19
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $655.91 / $728.79 / $925.56	Professional		$655.91	$728.79	$925.56
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $117.05 / $130.05 / $165.16	Professional	26	$117.05	$130.05	$165.16
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $538.87 / $598.74 / $760.40	Professional	TC	$538.87	$598.74	$760.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $563.08 / $922.90 / $1,585.49	Professional		$563.08	$922.90	$1,585.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.16 / $170.89 / $298.08	Professional	26	$103.16	$170.89	$298.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $455.18 / $756.77 / $1,288.51	Professional	TC	$455.18	$756.77	$1,288.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $489.75 / $741.02 / $987.34	Professional		$489.75	$741.02	$987.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.68 / $128.94 / $175.35	Professional	26	$87.68	$128.94	$175.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $402.07 / $616.50 / $804.14	Professional	TC	$402.07	$616.50	$804.14
United Facility/Professional Professional Modifier Low / Median / High Price $540.30 / $715.17 / $1,184.90	Professional		$540.30	$715.17	$1,184.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $98.09 / $145.03 / $231.71	Professional	26	$98.09	$145.03	$231.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $435.68 / $615.40 / $1,152.40	Professional	TC	$435.68	$615.40	$1,152.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $628.08 / $741.02 / $926.28	Professional		$628.08	$741.02	$926.28
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $112.43 / $134.44 / $170.40	Professional	26	$112.43	$134.44	$170.40
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $515.65 / $604.69 / $755.87	Professional	TC	$515.65	$604.69	$755.87