Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.01 / $45.01 / $45.01	Facility	26	$45.01	$45.01	$45.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $187.46 / $208.70 / $502.39	Professional		$187.46	$208.70	$502.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.01 / $49.21 / $132.96	Professional	26	$45.01	$49.21	$132.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.50 / $157.00 / $381.73	Professional	TC	$136.50	$157.00	$381.73
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $255.20 / $283.02 / $323.49	Professional		$255.20	$283.02	$323.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $56.15 / $62.39 / $71.31	Professional	26	$56.15	$62.39	$71.31
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $199.25 / $220.63 / $252.18	Professional	TC	$199.25	$220.63	$252.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $180.75 / $308.45 / $565.22	Professional		$180.75	$308.45	$565.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.50 / $62.43 / $122.65	Professional	26	$40.50	$62.43	$122.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $137.22 / $234.33 / $427.21	Professional	TC	$137.22	$234.33	$427.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $209.21 / $247.51 / $403.42	Professional		$209.21	$247.51	$403.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.62 / $60.41 / $85.74	Professional	26	$51.62	$60.41	$85.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $156.83 / $188.20 / $317.67	Professional	TC	$156.83	$188.20	$317.67
United Facility/Professional Professional Modifier Low / Median / High Price $137.11 / $240.71 / $400.74	Professional		$137.11	$240.71	$400.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.99 / $57.02 / $109.53	Professional	26	$22.99	$57.02	$109.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.39 / $179.01 / $304.89	Professional	TC	$100.39	$179.01	$304.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $168.10 / $229.18 / $297.93	Professional		$168.10	$229.18	$297.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $41.89 / $54.92 / $71.40	Professional	26	$41.89	$54.92	$71.40
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $126.21 / $174.26 / $222.78	Professional	TC	$126.21	$174.26	$222.78