Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.29 / $57.23 / $94.12	Facility	26	$47.29	$57.23	$94.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $185.86 / $267.52 / $917.20	Professional		$185.86	$267.52	$917.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.72 / $57.84 / $255.77	Professional	26	$47.72	$57.84	$255.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.57 / $205.53 / $440.97	Professional	TC	$138.57	$205.53	$440.97
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $259.14 / $276.83 / $316.42	Professional		$259.14	$276.83	$316.42
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $55.48 / $60.83 / $71.30	Professional	26	$55.48	$60.83	$71.30
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $194.96 / $216.00 / $246.89	Professional	TC	$194.96	$216.00	$246.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $179.95 / $316.20 / $563.09	Professional		$179.95	$316.20	$563.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.57 / $65.22 / $124.11	Professional	26	$42.57	$65.22	$124.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $135.38 / $247.31 / $418.03	Professional	TC	$135.38	$247.31	$418.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $210.35 / $271.35 / $458.62	Professional		$210.35	$271.35	$458.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.28 / $66.04 / $97.59	Professional	26	$54.28	$66.04	$97.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $155.32 / $200.36 / $343.12	Professional	TC	$155.32	$200.36	$343.12
United Facility/Professional Professional Modifier Low / Median / High Price $143.05 / $239.43 / $423.40	Professional		$143.05	$239.43	$423.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.39 / $62.30 / $101.42	Professional	26	$27.39	$62.30	$101.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.13 / $194.61 / $323.30	Professional	TC	$128.13	$194.61	$323.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $168.28 / $229.31 / $298.10	Professional		$168.28	$229.31	$298.10
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.02 / $57.74 / $75.06	Professional	26	$44.02	$57.74	$75.06
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $124.26 / $171.56 / $219.33	Professional	TC	$124.26	$171.56	$219.33