Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $58.88 / $66.07	Facility	26	$48.98	$58.88	$66.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $263.03 / $831.76	Professional		$138.04	$263.03	$831.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $100.00 / $194.98	Professional	26	$52.48	$100.00	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $138.04 / $512.86	Professional	TC	$81.28	$138.04	$512.86
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $173.78 / $263.03	Professional		$72.44	$173.78	$263.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $66.07 / $102.33	Professional	26	$61.66	$66.07	$102.33
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $120.23 / $138.04	Professional	TC	$107.15	$120.23	$138.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $91.20 / $91.20	Facility	26	$91.20	$91.20	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $223.87 / $426.58	Professional		$120.23	$223.87	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $66.07 / $125.89	Professional	26	$43.65	$66.07	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $147.91 / $288.40	Professional	TC	$72.44	$147.91	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $162.18 / $295.12	Professional		$141.25	$162.18	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $63.10 / $85.11	Professional	26	$54.95	$63.10	$85.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $100.00 / $204.17	Professional	TC	$87.10	$100.00	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $194.98 / $354.81	Professional		$120.23	$194.98	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $61.66 / $107.15	Professional	26	$33.88	$61.66	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $120.23 / $251.19	Professional	TC	$79.43	$120.23	$251.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $165.96 / $223.87	Professional		$144.54	$165.96	$223.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $66.07 / $85.11	Professional	26	$56.23	$66.07	$85.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $100.00 / $138.04	Professional	TC	$87.10	$100.00	$138.04