Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.48 / $140.59 / $142.18	Facility	26	$112.48	$140.59	$142.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $593.96 / $703.70 / $1,627.07	Professional		$593.96	$703.70	$1,627.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.42 / $136.03 / $349.98	Professional	26	$111.42	$136.03	$349.98
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $258.77 / $318.50 / $467.76	Professional	52	$258.77	$318.50	$467.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $476.14 / $558.16 / $1,000.00	Professional	TC	$476.14	$558.16	$1,000.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $689.82 / $766.47 / $973.42	Professional		$689.82	$766.47	$973.42
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $121.75 / $135.27 / $171.79	Professional	26	$121.75	$135.27	$171.79
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $568.08 / $631.20 / $801.62	Professional	TC	$568.08	$631.20	$801.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $589.80 / $972.01 / $1,655.08	Professional		$589.80	$972.01	$1,655.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.64 / $180.09 / $310.23	Professional	26	$107.64	$180.09	$310.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $477.11 / $799.69 / $1,356.42	Professional	TC	$477.11	$799.69	$1,356.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $512.99 / $776.06 / $1,027.52	Professional		$512.99	$776.06	$1,027.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.58 / $134.56 / $183.15	Professional	26	$91.58	$134.56	$183.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $421.43 / $646.19 / $842.85	Professional	TC	$421.43	$646.19	$842.85
United Facility/Professional Professional Modifier Low / Median / High Price $564.46 / $797.29 / $1,249.99	Professional		$564.46	$797.29	$1,249.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $106.35 / $147.62 / $238.59	Professional	26	$106.35	$147.62	$238.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $455.91 / $656.43 / $1,021.93	Professional	TC	$455.91	$656.43	$1,021.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $683.99 / $776.06 / $970.08	Professional		$683.99	$776.06	$970.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $122.09 / $140.41 / $177.73	Professional	26	$122.09	$140.41	$177.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $561.90 / $633.88 / $792.35	Professional	TC	$561.90	$633.88	$792.35