Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.94 / $51.94 / $62.84	Facility	26	$51.94	$51.94	$62.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.92 / $275.00 / $1,118.47	Professional		$169.92	$275.00	$1,118.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.94 / $64.70 / $187.68	Professional	26	$51.94	$64.70	$187.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.98 / $162.81 / $553.99	Professional	TC	$117.98	$162.81	$553.99
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $259.05 / $287.83 / $365.56	Professional		$259.05	$287.83	$365.56
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $67.67 / $74.17 / $94.20	Professional	26	$67.67	$74.17	$94.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $185.20 / $213.67 / $271.36	Professional	TC	$185.20	$213.67	$271.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $164.40 / $312.64 / $552.13	Professional		$164.40	$312.64	$552.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.51 / $76.81 / $140.28	Professional	26	$46.51	$76.81	$140.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $115.75 / $227.26 / $439.54	Professional	TC	$115.75	$227.26	$439.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $193.48 / $249.59 / $456.59	Professional		$193.48	$249.59	$456.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.26 / $73.64 / $119.36	Professional	26	$59.26	$73.64	$119.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $133.35 / $172.02 / $341.44	Professional	TC	$133.35	$172.02	$341.44
United Facility/Professional Professional Modifier Low / Median / High Price $171.33 / $237.81 / $540.49	Professional		$171.33	$237.81	$540.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.11 / $64.68 / $111.68	Professional	26	$28.11	$64.68	$111.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.09 / $186.46 / $423.79	Professional	TC	$122.09	$186.46	$423.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $154.78 / $210.31 / $273.39	Professional		$154.78	$210.31	$273.39
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $48.10 / $63.04 / $81.95	Professional	26	$48.10	$63.04	$81.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $106.68 / $147.27 / $188.27	Professional	TC	$106.68	$147.27	$188.27