Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.00 / $126.00 / $126.00	Facility	26	$126.00	$126.00	$126.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $333.64 / $475.00 / $1,175.39	Professional		$333.64	$475.00	$1,175.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.30 / $126.00 / $200.20	Professional	26	$75.30	$126.00	$200.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $276.73 / $335.00 / $801.32	Professional	TC	$276.73	$335.00	$801.32
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $457.99 / $511.78 / $584.96	Professional		$457.99	$511.78	$584.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $69.80 / $79.08 / $90.39	Professional	26	$69.80	$79.08	$90.39
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $388.19 / $432.70 / $494.58	Professional	TC	$388.19	$432.70	$494.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $305.39 / $562.89 / $952.30	Professional		$305.39	$562.89	$952.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.85 / $82.06 / $156.13	Professional	26	$53.85	$82.06	$156.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $249.36 / $469.44 / $769.77	Professional	TC	$249.36	$469.44	$769.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $353.33 / $447.40 / $772.88	Professional		$353.33	$447.40	$772.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.62 / $82.94 / $113.34	Professional	26	$68.62	$82.94	$113.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $283.70 / $365.99 / $626.90	Professional	TC	$283.70	$365.99	$626.90
United Facility/Professional Professional Modifier Low / Median / High Price $284.79 / $498.18 / $943.58	Professional		$284.79	$498.18	$943.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.99 / $74.38 / $123.11	Professional	26	$28.99	$74.38	$123.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $248.78 / $358.97 / $720.06	Professional	TC	$248.78	$358.97	$720.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $264.52 / $361.38 / $469.79	Professional		$264.52	$361.38	$469.79
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $55.70 / $73.00 / $94.90	Professional	26	$55.70	$73.00	$94.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $208.84 / $288.38 / $368.67	Professional	TC	$208.84	$288.38	$368.67