Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $43.65 / $50.12	Facility	26	$36.31	$43.65	$50.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $165.96 / $630.96	Professional		$114.82	$165.96	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $66.07 / $114.82	Professional	26	$34.67	$66.07	$114.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $104.71 / $251.19	Professional	TC	$79.43	$104.71	$251.19
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $138.04 / $158.49	Professional		$64.57	$138.04	$158.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $43.65 / $45.71	Professional	26	$38.02	$43.65	$45.71
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $109.65 / $123.03	Professional	TC	$93.33	$109.65	$123.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $69.18 / $69.18	Facility	26	$69.18	$69.18	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $138.04 / $275.42	Professional		$104.71	$138.04	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $40.74 / $91.20	Professional	26	$28.84	$40.74	$91.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $104.71 / $213.80	Professional	TC	$72.44	$104.71	$213.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $158.49 / $218.78	Professional		$134.90	$158.49	$218.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $46.77 / $64.57	Professional	26	$39.81	$46.77	$64.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $109.65 / $154.88	Professional	TC	$95.50	$109.65	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $138.04 / $245.47	Professional		$95.50	$138.04	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $41.69 / $77.62	Professional	26	$26.92	$41.69	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $95.50 / $169.82	Professional	TC	$64.57	$95.50	$169.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $165.96 / $223.87	Professional		$100.00	$165.96	$223.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $50.12 / $64.57	Professional	26	$30.20	$50.12	$64.57
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $114.82 / $158.49	Professional	TC	$70.79	$114.82	$158.49