Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $44.67 / $44.67	Facility	26	$44.67	$44.67	$44.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $245.47 / $741.31	Professional		$181.97	$245.47	$741.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $57.54 / $199.53	Professional	26	$43.65	$57.54	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $169.82 / $371.54	Professional	TC	$134.90	$169.82	$371.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $223.87 / $257.04	Professional		$173.78	$223.87	$257.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $54.95 / $60.26	Professional	26	$48.98	$54.95	$60.26
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $173.78 / $194.98	Professional	TC	$154.88	$173.78	$194.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $85.11 / $85.11	Facility	26	$85.11	$85.11	$85.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $275.42 / $549.54	Professional		$173.78	$275.42	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $60.26 / $117.49	Professional	26	$40.74	$60.26	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $204.17 / $389.05	Professional	TC	$128.82	$204.17	$389.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $229.09 / $323.59	Professional		$204.17	$229.09	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $57.54 / $77.62	Professional	26	$50.12	$57.54	$77.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $173.78 / $251.19	Professional	TC	$154.88	$173.78	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $239.88 / $416.87	Professional		$141.25	$239.88	$416.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $57.54 / $95.50	Professional	26	$33.88	$57.54	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $186.21 / $323.59	Professional	TC	$107.15	$186.21	$323.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $239.88 / $331.13	Professional		$208.93	$239.88	$331.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $60.26 / $79.43	Professional	26	$51.29	$60.26	$79.43
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $181.97 / $251.19	Professional	TC	$154.88	$181.97	$251.19