Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $79.43 / $131.83	Facility	26	$66.07	$79.43	$131.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $363.08 / $1,412.54	Professional		$218.78	$363.08	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $112.20 / $223.87	Professional	26	$67.61	$112.20	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $218.78 / $537.03	Professional	TC	$144.54	$218.78	$537.03
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $281.84 / $346.74	Professional		$194.98	$281.84	$346.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $97.72 / $109.65	Professional	26	$83.18	$97.72	$109.65
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $213.80 / $251.19	Professional	TC	$190.55	$213.80	$251.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $123.03 / $123.03	Facility	26	$123.03	$123.03	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $346.74 / $616.60	Professional		$194.98	$346.74	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $83.18 / $158.49	Professional	26	$57.54	$83.18	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $245.47 / $467.74	Professional	TC	$131.83	$245.47	$467.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $263.03 / $446.68	Professional		$229.09	$263.03	$446.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $85.11 / $114.82	Professional	26	$74.13	$85.11	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $181.97 / $346.74	Professional	TC	$154.88	$181.97	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $295.12 / $512.86	Professional		$194.98	$295.12	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $79.43 / $141.25	Professional	26	$40.74	$79.43	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $213.80 / $398.11	Professional	TC	$141.25	$213.80	$398.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $269.15 / $363.08	Professional		$234.42	$269.15	$363.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $89.13 / $114.82	Professional	26	$75.86	$89.13	$114.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $181.97 / $251.19	Professional	TC	$154.88	$181.97	$251.19