Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.57 / $70.43 / $98.66	Facility	26	$49.57	$70.43	$98.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $160.91 / $275.00 / $952.69	Professional		$160.91	$275.00	$952.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.41 / $61.64 / $268.42	Professional	26	$51.41	$61.64	$268.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $105.45 / $192.00 / $450.20	Professional	TC	$105.45	$192.00	$450.20
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $240.94 / $282.06 / $319.18	Professional		$240.94	$282.06	$319.18
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.28 / $63.79 / $74.78	Professional	26	$58.28	$63.79	$74.78
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $166.15 / $218.27 / $247.00	Professional	TC	$166.15	$218.27	$247.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $150.59 / $303.92 / $484.84	Professional		$150.59	$303.92	$484.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.64 / $68.39 / $130.37	Professional	26	$44.64	$68.39	$130.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $103.85 / $221.30 / $378.68	Professional	TC	$103.85	$221.30	$378.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.81 / $229.37 / $386.38	Professional		$177.81	$229.37	$386.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.94 / $69.25 / $102.87	Professional	26	$56.94	$69.25	$102.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.10 / $154.93 / $298.61	Professional	TC	$120.10	$154.93	$298.61
United Facility/Professional Professional Modifier Low / Median / High Price $141.83 / $228.16 / $453.77	Professional		$141.83	$228.16	$453.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.72 / $62.44 / $102.46	Professional	26	$28.72	$62.44	$102.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.61 / $166.59 / $370.80	Professional	TC	$116.61	$166.59	$370.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $142.25 / $193.19 / $251.15	Professional		$142.25	$193.19	$251.15
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.17 / $60.57 / $78.73	Professional	26	$46.17	$60.57	$78.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $96.08 / $132.62 / $169.53	Professional	TC	$96.08	$132.62	$169.53