Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.28 / $49.28 / $49.28	Facility	26	$49.28	$49.28	$49.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $179.49 / $260.86 / $1,007.05	Professional		$179.49	$260.86	$1,007.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.28 / $56.03 / $155.79	Professional	26	$49.28	$56.03	$155.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $130.21 / $192.00 / $549.58	Professional	TC	$130.21	$192.00	$549.58
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $279.50 / $303.07 / $355.85	Professional		$279.50	$303.07	$355.85
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.28 / $79.23 / $89.66	Professional	26	$58.28	$79.23	$89.66
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $205.20 / $223.84 / $292.06	Professional	TC	$205.20	$223.84	$292.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $174.69 / $364.14 / $581.67	Professional		$174.69	$364.14	$581.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.37 / $67.62 / $133.00	Professional	26	$44.37	$67.62	$133.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.25 / $283.07 / $467.15	Professional	TC	$128.25	$283.07	$467.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $205.36 / $264.91 / $458.27	Professional		$205.36	$264.91	$458.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.57 / $68.83 / $102.30	Professional	26	$56.57	$68.83	$102.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $148.00 / $190.92 / $367.04	Professional	TC	$148.00	$190.92	$367.04
United Facility/Professional Professional Modifier Low / Median / High Price $174.12 / $281.64 / $545.15	Professional		$174.12	$281.64	$545.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.76 / $65.39 / $107.14	Professional	26	$35.76	$65.39	$107.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $146.44 / $210.47 / $427.45	Professional	TC	$146.44	$210.47	$427.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $164.29 / $223.65 / $290.75	Professional		$164.29	$223.65	$290.75
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.89 / $60.18 / $78.23	Professional	26	$45.89	$60.18	$78.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $118.40 / $163.47 / $208.98	Professional	TC	$118.40	$163.47	$208.98