Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.31 / $54.99 / $57.33	Facility	26	$40.31	$54.99	$57.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.22 / $142.88 / $497.00	Professional		$104.22	$142.88	$497.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.90 / $66.20 / $181.00	Professional	26	$40.90	$66.20	$181.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.91 / $81.31 / $175.29	Professional	TC	$63.91	$81.31	$175.29
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $118.77 / $138.38 / $177.14	Professional		$118.77	$138.38	$177.14
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $46.80 / $52.00 / $72.54	Professional	26	$46.80	$52.00	$72.54
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $73.09 / $86.39 / $109.72	Professional	TC	$73.09	$86.39	$109.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.98 / $147.38 / $274.94	Professional		$92.98	$147.38	$274.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.18 / $57.15 / $105.18	Professional	26	$36.18	$57.15	$105.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.43 / $90.76 / $172.46	Professional	TC	$56.43	$90.76	$172.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.21 / $149.72 / $252.63	Professional		$120.21	$149.72	$252.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.15 / $57.07 / $97.92	Professional	26	$47.15	$57.07	$97.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.95 / $91.19 / $133.25	Professional	TC	$72.95	$91.19	$133.25
United Facility/Professional Professional Modifier Low / Median / High Price $102.20 / $124.51 / $304.29	Professional		$102.20	$124.51	$304.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.68 / $48.88 / $90.81	Professional	26	$37.68	$48.88	$90.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.94 / $80.69 / $136.62	Professional	TC	$62.94	$80.69	$136.62
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $101.98 / $138.24 / $171.75	Professional		$101.98	$138.24	$171.75
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $40.09 / $54.35 / $68.75	Professional	26	$40.09	$54.35	$68.75
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $61.89 / $83.89 / $104.75	Professional	TC	$61.89	$83.89	$104.75