Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $70.79	Facility	26	$51.29	$51.29	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $302.00 / $851.14	Professional		$208.93	$302.00	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $85.11 / $199.53	Professional	26	$54.95	$85.11	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $218.78 / $549.54	Professional	TC	$151.36	$218.78	$549.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $295.12 / $346.74	Professional		$89.13	$295.12	$346.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $77.62 / $81.28	Professional	26	$67.61	$77.62	$81.28
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $223.87 / $245.47	Professional	TC	$199.53	$223.87	$245.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $97.72 / $97.72	Facility	26	$97.72	$97.72	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $346.74 / $660.69	Professional		$186.21	$346.74	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $77.62 / $141.25	Professional	26	$46.77	$77.62	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $263.03 / $501.19	Professional	TC	$138.04	$263.03	$501.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $251.19 / $478.63	Professional		$218.78	$251.19	$478.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $66.07 / $91.20	Professional	26	$58.88	$66.07	$91.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $186.21 / $363.08	Professional	TC	$158.49	$186.21	$363.08
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $316.23 / $549.54	Professional		$194.98	$316.23	$549.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $67.61 / $120.23	Professional	26	$41.69	$67.61	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $245.47 / $436.52	Professional	TC	$154.88	$245.47	$436.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $257.04 / $346.74	Professional		$218.78	$257.04	$346.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $69.18 / $91.20	Professional	26	$60.26	$69.18	$91.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $186.21 / $257.04	Professional	TC	$162.18	$186.21	$257.04