Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.28 / $54.98 / $80.17	Facility	26	$40.28	$54.98	$80.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.92 / $231.53 / $732.67	Professional		$117.92	$231.53	$732.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $51.59 / $163.68	Professional	26	$41.81	$51.59	$163.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.64 / $140.40 / $306.32	Professional	TC	$77.64	$140.40	$306.32
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $183.58 / $225.47 / $293.11	Professional		$183.58	$225.47	$293.11
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $51.90 / $55.10 / $68.20	Professional	26	$51.90	$55.10	$68.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $122.36 / $173.57 / $225.64	Professional	TC	$122.36	$173.57	$225.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.74 / $244.89 / $408.69	Professional		$114.74	$244.89	$408.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $60.87 / $109.51	Professional	26	$36.54	$60.87	$109.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.24 / $171.19 / $302.77	Professional	TC	$83.24	$171.19	$302.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $135.88 / $175.29 / $295.02	Professional		$135.88	$175.29	$295.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.61 / $56.69 / $97.59	Professional	26	$46.61	$56.69	$97.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $88.64 / $114.35 / $219.74	Professional	TC	$88.64	$114.35	$219.74
United Facility/Professional Professional Modifier Low / Median / High Price $125.17 / $188.82 / $360.70	Professional		$125.17	$188.82	$360.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.05 / $54.00 / $95.01	Professional	26	$29.05	$54.00	$95.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $132.80 / $271.56	Professional	TC	$90.19	$132.80	$271.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $108.70 / $147.51 / $191.76	Professional		$108.70	$147.51	$191.76
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $49.58 / $64.45	Professional	26	$37.79	$49.58	$64.45
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $70.91 / $97.93 / $125.19	Professional	TC	$70.91	$97.93	$125.19