Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.86 / $30.86 / $30.86	Facility	26	$30.86	$30.86	$30.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.67 / $147.08 / $438.85	Professional		$127.67	$147.08	$438.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.50 / $36.17 / $166.50	Professional	26	$30.50	$36.17	$166.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.93 / $111.58 / $291.77	Professional	TC	$96.93	$111.58	$291.77
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $152.36 / $169.29 / $236.16	Professional		$152.36	$169.29	$236.16
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $35.72 / $39.68 / $57.93	Professional	26	$35.72	$39.68	$57.93
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $116.64 / $129.60 / $180.79	Professional	TC	$116.64	$129.60	$180.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.38 / $166.75 / $337.76	Professional		$117.38	$166.75	$337.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.66 / $40.10 / $78.30	Professional	26	$27.66	$40.10	$78.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.54 / $126.70 / $258.42	Professional	TC	$88.54	$126.70	$258.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.75 / $182.10 / $274.50	Professional		$151.75	$182.10	$274.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.01 / $43.42 / $59.53	Professional	26	$36.01	$43.42	$59.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $115.57 / $140.37 / $215.30	Professional	TC	$115.57	$140.37	$215.30
United Facility/Professional Professional Modifier Low / Median / High Price $112.39 / $155.62 / $292.77	Professional		$112.39	$155.62	$292.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.22 / $35.29 / $68.90	Professional	26	$26.22	$35.29	$68.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.12 / $130.35 / $222.40	Professional	TC	$86.12	$130.35	$222.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $125.86 / $174.51 / $215.64	Professional		$125.86	$174.51	$215.64
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.01 / $41.61 / $52.52	Professional	26	$30.01	$41.61	$52.52
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.85 / $132.91 / $165.89	Professional	TC	$95.85	$132.91	$165.89