Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.28 / $43.53 / $49.48	Facility	26	$36.28	$43.53	$49.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.14 / $135.71 / $695.00	Professional		$109.14	$135.71	$695.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.20 / $37.63 / $97.23	Professional	26	$31.20	$37.63	$97.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.23 / $98.08 / $239.45	Professional	TC	$79.23	$98.08	$239.45
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $107.91 / $142.69 / $163.09	Professional		$107.91	$142.69	$163.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $35.96 / $38.65 / $44.17	Professional	26	$35.96	$38.65	$44.17
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $71.14 / $104.04 / $117.73	Professional	TC	$71.14	$104.04	$117.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.92 / $144.94 / $314.06	Professional		$105.92	$144.94	$314.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.25 / $42.28 / $92.14	Professional	26	$30.25	$42.28	$92.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.59 / $108.27 / $216.38	Professional	TC	$75.59	$108.27	$216.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $130.66 / $162.50 / $251.61	Professional		$130.66	$162.50	$251.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.93 / $48.93 / $67.50	Professional	26	$37.93	$48.93	$67.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $93.94 / $114.57 / $181.97	Professional	TC	$93.94	$114.57	$181.97
United Facility/Professional Professional Modifier Low / Median / High Price $98.46 / $141.21 / $307.57	Professional		$98.46	$141.21	$307.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.74 / $40.74 / $75.76	Professional	26	$26.74	$40.74	$75.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.06 / $94.56 / $177.04	Professional	TC	$69.06	$94.56	$177.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $100.91 / $153.72 / $201.34	Professional		$100.91	$153.72	$201.34
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.38 / $45.36 / $61.86	Professional	26	$30.38	$45.36	$61.86
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $70.53 / $109.11 / $139.47	Professional	TC	$70.53	$109.11	$139.47