Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $141.25 / $151.36	Facility	26	$112.20	$141.25	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $758.58 / $1,621.81	Professional		$588.84	$758.58	$1,621.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $186.21 / $512.86	Professional	26	$117.49	$186.21	$512.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $190.55 / $371.54 / $1,258.93	Professional	52	$190.55	$371.54	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $588.84 / $1,122.02	Professional	TC	$467.74	$588.84	$1,122.02
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $776.25 / $1,071.52	Professional		$120.23	$776.25	$1,071.52
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $134.90 / $457.09	Professional	26	$134.90	$134.90	$457.09
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $645.65 / $794.33	Professional	TC	$588.84	$645.65	$794.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $933.25 / $1,621.81	Professional		$616.60	$933.25	$1,621.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $173.78 / $309.03	Professional	26	$112.20	$173.78	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $741.31 / $1,348.96	Professional	TC	$489.78	$741.31	$1,348.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $831.76 / $1,148.15	Professional		$562.34	$831.76	$1,148.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $138.04 / $194.98	Professional	26	$95.50	$138.04	$194.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $691.83 / $933.25	Professional	TC	$467.74	$691.83	$933.25
United Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $831.76 / $1,380.38	Professional		$562.34	$831.76	$1,380.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $162.18 / $263.03	Professional	26	$109.65	$162.18	$263.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $676.08 / $1,122.02	Professional	TC	$457.09	$676.08	$1,122.02
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $870.96 / $1,071.52	Professional		$691.83	$870.96	$1,071.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $147.91 / $186.21	Professional	26	$123.03	$147.91	$186.21
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $724.44 / $891.25	Professional	TC	$562.34	$724.44	$891.25