Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $60.26 / $60.26	Facility	26	$50.12	$60.26	$60.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $309.03 / $1,348.96	Professional		$223.87	$309.03	$1,348.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $177.83	Professional	26	$53.70	$85.11	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $229.09 / $549.54	Professional	TC	$162.18	$229.09	$549.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $331.13 / $389.05	Professional		$263.03	$331.13	$389.05
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $72.44 / $83.18	Professional	26	$63.10	$72.44	$83.18
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $288.40 / $331.13	Professional	TC	$251.19	$288.40	$331.13
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 $218.78 / $371.54 / $691.83	Professional		$218.78	$371.54	$691.83
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 $169.82 / $295.12 / $562.34	Professional	TC	$169.82	$295.12	$562.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $302.00 / $446.68	Professional		$263.03	$302.00	$446.68
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 $204.17 / $239.88 / $380.19	Professional	TC	$204.17	$239.88	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $331.13 / $537.03	Professional		$218.78	$331.13	$537.03
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 $169.82 / $263.03 / $457.09	Professional	TC	$169.82	$263.03	$457.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $288.40 / $389.05	Professional		$251.19	$288.40	$389.05
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 $190.55 / $223.87 / $295.12	Professional	TC	$190.55	$223.87	$295.12