Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.61 / $151.19 / $250.74	Facility	26	$74.61	$151.19	$250.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $286.88 / $475.00 / $1,495.17	Professional		$286.88	$475.00	$1,495.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.62 / $140.00 / $337.68	Professional	26	$70.62	$140.00	$337.68
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $119.91 / $168.91 / $2,148.37	Professional	50	$119.91	$168.91	$2,148.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $250.40 / $335.00 / $842.82	Professional	TC	$250.40	$335.00	$842.82
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $393.17 / $458.47 / $527.24	Professional		$393.17	$458.47	$527.24
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $64.53 / $72.91 / $87.95	Professional	26	$64.53	$72.91	$87.95
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $317.41 / $385.56 / $443.39	Professional	TC	$317.41	$385.56	$443.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $200.44 / $457.65 / $765.93	Professional		$200.44	$457.65	$765.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.63 / $75.78 / $147.83	Professional	26	$49.63	$75.78	$147.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.78 / $335.04 / $626.92	Professional	TC	$148.78	$335.04	$626.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.13 / $302.02 / $510.14	Professional		$234.13	$302.02	$510.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.28 / $77.00 / $104.45	Professional	26	$63.28	$77.00	$104.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $169.96 / $219.25 / $409.21	Professional	TC	$169.96	$219.25	$409.21
United Facility/Professional Professional Modifier Low / Median / High Price $217.88 / $334.45 / $661.65	Professional		$217.88	$334.45	$661.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.63 / $71.79 / $141.06	Professional	26	$33.63	$71.79	$141.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $164.74 / $253.42 / $621.20	Professional	TC	$164.74	$253.42	$621.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $187.30 / $255.07 / $331.59	Professional		$187.30	$255.07	$331.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.34 / $67.31 / $87.52	Professional	26	$51.34	$67.31	$87.52
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $135.97 / $187.76 / $240.03	Professional	TC	$135.97	$187.76	$240.03