Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $61.66 / $100.00	Facility	26	$51.29	$61.66	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $302.00 / $1,288.25	Professional		$194.98	$302.00	$1,288.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $104.71 / $239.88	Professional	26	$54.95	$104.71	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $218.78 / $549.54	Professional	TC	$134.90	$218.78	$549.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $251.19 / $338.84	Professional		$69.18	$251.19	$338.84
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $75.86 / $89.13	Professional	26	$64.57	$75.86	$89.13
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $204.17 / $269.15	Professional	TC	$181.97	$204.17	$269.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $95.50 / $95.50	Facility	26	$95.50	$95.50	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $331.13 / $602.56	Professional		$173.78	$331.13	$602.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $75.86 / $138.04	Professional	26	$45.71	$75.86	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $245.47 / $467.74	Professional	TC	$125.89	$245.47	$467.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $234.42 / $446.68	Professional		$204.17	$234.42	$446.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $66.07 / $89.13	Professional	26	$57.54	$66.07	$89.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $169.82 / $338.84	Professional	TC	$147.91	$169.82	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $302.00 / $537.03	Professional		$190.55	$302.00	$537.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $70.79 / $123.03	Professional	26	$38.90	$70.79	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $218.78 / $416.87	Professional	TC	$141.25	$218.78	$416.87
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $239.88 / $323.59	Professional		$204.17	$239.88	$323.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $69.18 / $89.13	Professional	26	$58.88	$69.18	$89.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $169.82 / $234.42	Professional	TC	$147.91	$169.82	$234.42