Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $125.89 / $173.78	Facility	26	$66.07	$125.89	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $426.58 / $977.24	Professional		$218.78	$426.58	$977.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $120.23 / $316.23	Professional	26	$57.54	$120.23	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $302.00 / $660.69	Professional	TC	$177.83	$302.00	$660.69
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $323.59 / $436.52	Professional		$251.19	$323.59	$436.52
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $70.79 / $87.10	Professional	26	$57.54	$70.79	$87.10
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $245.47 / $380.19	Professional	TC	$218.78	$245.47	$380.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $91.20 / $91.20	Facility	26	$91.20	$91.20	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $416.87 / $758.58	Professional		$190.55	$416.87	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $66.07 / $131.83	Professional	26	$43.65	$66.07	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $338.84 / $645.65	Professional	TC	$144.54	$338.84	$645.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $263.03 / $478.63	Professional		$223.87	$263.03	$478.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $63.10 / $85.11	Professional	26	$54.95	$63.10	$85.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $199.53 / $380.19	Professional	TC	$169.82	$199.53	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $323.59 / $691.83	Professional		$213.80	$323.59	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $61.66 / $104.71	Professional	26	$33.88	$61.66	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $251.19 / $588.84	Professional	TC	$165.96	$251.19	$588.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $263.03 / $363.08	Professional		$229.09	$263.03	$363.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $66.07 / $87.10	Professional	26	$56.23	$66.07	$87.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $194.98 / $275.42	Professional	TC	$169.82	$194.98	$275.42