Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $67.61 / $97.72	Facility	26	$50.12	$67.61	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $1,000.00	Professional		$169.82	$275.42	$1,000.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $97.72 / $218.78	Professional	26	$53.70	$97.72	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $190.55 / $446.68	Professional	TC	$114.82	$190.55	$446.68
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $239.88 / $281.84	Professional		$190.55	$239.88	$281.84
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $74.13 / $83.18	Professional	26	$58.88	$74.13	$83.18
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $165.96 / $194.98	Professional	TC	$147.91	$165.96	$194.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Facility	26	$93.33	$93.33	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $288.40 / $501.19	Professional		$147.91	$288.40	$501.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $67.61 / $123.03	Professional	26	$44.67	$67.61	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $194.98 / $380.19	Professional	TC	$100.00	$194.98	$380.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $204.17 / $371.54	Professional		$173.78	$204.17	$371.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $64.57 / $87.10	Professional	26	$56.23	$64.57	$87.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $138.04 / $269.15	Professional	TC	$120.23	$138.04	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $251.19 / $446.68	Professional		$158.49	$251.19	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $63.10 / $107.15	Professional	26	$34.67	$63.10	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $177.83 / $338.84	Professional	TC	$117.49	$177.83	$338.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $204.17 / $281.84	Professional		$177.83	$204.17	$281.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $67.61 / $87.10	Professional	26	$57.54	$67.61	$87.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $138.04 / $190.55	Professional	TC	$120.23	$138.04	$190.55