Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.75 / $57.75 / $57.75	Facility	26	$57.75	$57.75	$57.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $111.52 / $190.47 / $392.63	Professional		$111.52	$190.47	$392.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.13 / $59.08 / $154.77	Professional	26	$50.13	$59.08	$154.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.77 / $100.35 / $323.37	Professional	TC	$53.77	$100.35	$323.37
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $152.33 / $154.94 / $606.41	Professional		$152.33	$154.94	$606.41
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $59.64 / $61.50 / $75.95	Professional	26	$59.64	$61.50	$75.95
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $85.69 / $93.44 / $545.22	Professional	TC	$85.69	$93.44	$545.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.18 / $183.56 / $566.98	Professional		$101.18	$183.56	$566.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $69.62 / $144.66	Professional	26	$50.12	$69.62	$144.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.53 / $100.24 / $331.44	Professional	TC	$47.53	$100.24	$331.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $130.05 / $167.76 / $271.87	Professional		$130.05	$167.76	$271.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.68 / $78.90 / $108.81	Professional	26	$60.68	$78.90	$108.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $61.45 / $79.27 / $171.28	Professional	TC	$61.45	$79.27	$171.28
United Facility/Professional Professional Modifier Low / Median / High Price $122.21 / $194.77 / $370.23	Professional		$122.21	$194.77	$370.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.90 / $64.64 / $121.32	Professional	26	$44.90	$64.64	$121.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.08 / $99.87 / $305.76	Professional	TC	$61.08	$99.87	$305.76
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.04 / $138.52 / $184.62	Professional		$104.04	$138.52	$184.62
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $54.89 / $71.78 / $97.88	Professional	26	$54.89	$71.78	$97.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $49.16 / $67.84 / $86.75	Professional	TC	$49.16	$67.84	$86.75