Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $134.90 / $257.04	Facility	26	$34.67	$134.90	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $194.98 / $407.38	Professional		$91.20	$194.98	$407.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $83.18 / $208.93	Professional	26	$33.11	$83.18	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $67.61 / $199.53	Professional	TC	$56.23	$67.61	$199.53
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $120.23 / $331.13	Professional		$87.10	$120.23	$331.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $42.66 / $112.20	Professional	26	$38.02	$42.66	$112.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $77.62 / $87.10	Professional	TC	$70.79	$77.62	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $123.03 / $288.40	Professional		$93.33	$123.03	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $48.98 / $93.33	Professional	26	$31.62	$48.98	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $75.86 / $194.98	Professional	TC	$51.29	$75.86	$194.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $128.82 / $257.04	Professional		$117.49	$128.82	$257.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $44.67 / $89.13	Professional	26	$42.66	$44.67	$89.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $83.18 / $169.82	Professional	TC	$75.86	$83.18	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $112.20 / $331.13	Professional		$95.50	$112.20	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $42.66 / $114.82	Professional	26	$34.67	$42.66	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $72.44 / $218.78	Professional	TC	$61.66	$72.44	$218.78