Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.43 / $58.12 / $65.59	Facility	26	$48.43	$58.12	$65.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.88 / $237.27 / $761.00	Professional		$124.88	$237.27	$761.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.22 / $60.32 / $213.00	Professional	26	$50.22	$60.32	$213.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.44 / $138.22 / $509.77	Professional	TC	$76.44	$138.22	$509.77
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $187.39 / $208.21 / $270.67	Professional		$187.39	$208.21	$270.67
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $56.88 / $62.31 / $81.88	Professional	26	$56.88	$62.31	$81.88
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $120.46 / $145.90 / $195.54	Professional	TC	$120.46	$145.90	$195.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.94 / $230.88 / $402.69	Professional		$120.94	$230.88	$402.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.60 / $66.80 / $130.61	Professional	26	$43.60	$66.80	$130.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.28 / $153.15 / $282.83	Professional	TC	$75.28	$153.15	$282.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $142.91 / $184.37 / $308.27	Professional		$142.91	$184.37	$308.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.60 / $67.64 / $99.95	Professional	26	$55.60	$67.64	$99.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $86.55 / $111.65 / $216.46	Professional	TC	$86.55	$111.65	$216.46
United Facility/Professional Professional Modifier Low / Median / High Price $121.48 / $179.89 / $354.33	Professional		$121.48	$179.89	$354.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.76 / $60.99 / $99.94	Professional	26	$29.76	$60.99	$99.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.44 / $117.76 / $257.17	Professional	TC	$77.44	$117.76	$257.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.34 / $154.77 / $201.20	Professional		$114.34	$154.77	$201.20
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.10 / $59.15 / $76.90	Professional	26	$45.10	$59.15	$76.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $69.23 / $95.61 / $122.23	Professional	TC	$69.23	$95.61	$122.23