Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.95 / $38.95 / $38.95	Facility	26	$38.95	$38.95	$38.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.40 / $145.97 / $417.41	Professional		$115.40	$145.97	$417.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.95 / $48.07 / $128.96	Professional	26	$38.95	$48.07	$128.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.44 / $98.44 / $288.44	Professional	TC	$76.44	$98.44	$288.44
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $162.08 / $162.08 / $186.06	Professional		$162.08	$162.08	$186.06
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $46.76 / $50.80 / $58.46	Professional	26	$46.76	$50.80	$58.46
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $111.28 / $111.28 / $127.60	Professional	TC	$111.28	$111.28	$127.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.29 / $212.80 / $365.52	Professional		$116.29	$212.80	$365.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.01 / $53.84 / $104.94	Professional	26	$35.01	$53.84	$104.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.75 / $146.63 / $246.19	Professional	TC	$79.75	$146.63	$246.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $137.38 / $173.62 / $298.26	Professional		$137.38	$173.62	$298.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.51 / $54.31 / $82.31	Professional	26	$44.51	$54.31	$82.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.13 / $118.85 / $203.56	Professional	TC	$92.13	$118.85	$203.56
United Facility/Professional Professional Modifier Low / Median / High Price $91.23 / $161.57 / $266.20	Professional		$91.23	$161.57	$266.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.94 / $50.65 / $91.64	Professional	26	$28.94	$50.65	$91.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.50 / $112.36 / $206.46	Professional	TC	$73.50	$112.36	$206.46
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $106.69 / $149.13 / $193.87	Professional		$106.69	$149.13	$193.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.14 / $47.35 / $61.56	Professional	26	$35.14	$47.35	$61.56
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $71.55 / $101.78 / $130.13	Professional	TC	$71.55	$101.78	$130.13