Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.59 / $64.41 / $94.70	Facility	26	$47.59	$64.41	$94.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $122.77 / $269.36 / $1,033.88	Professional		$122.77	$269.36	$1,033.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.70 / $62.43 / $217.21	Professional	26	$49.70	$62.43	$217.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $105.45 / $191.27 / $450.20	Professional	TC	$105.45	$191.27	$450.20
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $238.40 / $282.33 / $367.04	Professional		$238.40	$282.33	$367.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $59.65 / $64.91 / $85.29	Professional	26	$59.65	$64.91	$85.29
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $166.63 / $217.43 / $280.64	Professional	TC	$166.63	$217.43	$280.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $149.00 / $304.49 / $490.95	Professional		$149.00	$304.49	$490.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.84 / $69.09 / $128.21	Professional	26	$42.84	$69.09	$128.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.10 / $220.76 / $378.68	Professional	TC	$112.10	$220.76	$378.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $175.48 / $226.37 / $381.50	Professional		$175.48	$226.37	$381.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.64 / $66.45 / $104.07	Professional	26	$54.64	$66.45	$104.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.10 / $154.93 / $298.20	Professional	TC	$120.10	$154.93	$298.20
United Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $258.70 / $446.58	Professional		$162.18	$258.70	$446.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.29 / $59.91 / $104.67	Professional	26	$29.29	$59.91	$104.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.69 / $163.10 / $340.06	Professional	TC	$115.69	$163.10	$340.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $140.38 / $190.75 / $247.98	Professional		$140.38	$190.75	$247.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.30 / $58.13 / $75.56	Professional	26	$44.30	$58.13	$75.56
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $96.08 / $132.62 / $169.53	Professional	TC	$96.08	$132.62	$169.53