Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.00 / $140.66 / $353.48	Facility	26	$115.00	$140.66	$353.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $153.04 / $165.55 / $316.16	Professional		$153.04	$165.55	$316.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.59 / $49.36 / $119.45	Professional	26	$47.59	$49.36	$119.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $105.45 / $116.19 / $259.17	Professional	TC	$105.45	$116.19	$259.17
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $238.40 / $282.33 / $988.57	Professional		$238.40	$282.33	$988.57
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $64.59 / $70.75 / $107.10	Professional	26	$64.59	$70.75	$107.10
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $166.63 / $217.43 / $358.76	Professional	TC	$166.63	$217.43	$358.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $232.84 / $389.85 / $776.86	Professional		$232.84	$389.85	$776.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.50 / $84.95 / $226.99	Professional	26	$46.50	$84.95	$226.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $159.41 / $318.45 / $549.87	Professional	TC	$159.41	$318.45	$549.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.21 / $403.84 / $403.84	Professional		$181.21	$403.84	$403.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.22 / $121.58 / $121.58	Professional	26	$55.22	$121.58	$121.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.99 / $282.26 / $282.26	Professional	TC	$125.99	$282.26	$282.26
United Facility/Professional Professional Modifier Low / Median / High Price $156.47 / $282.83 / $612.97	Professional		$156.47	$282.83	$612.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.21 / $70.42 / $184.54	Professional	26	$42.21	$70.42	$184.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $121.80 / $198.32 / $428.43	Professional	TC	$121.80	$198.32	$428.43