Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.27 / $92.53 / $1,246.71	Facility		$61.27	$92.53	$1,246.71
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.94 / $35.33 / $36.67	Facility	26	$25.94	$35.33	$36.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.06 / $120.62 / $463.61	Professional		$51.06	$120.62	$463.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.77 / $33.88 / $148.94	Professional	26	$26.77	$33.88	$148.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.94 / $51.42 / $187.42	Professional	TC	$23.94	$51.42	$187.42
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $57.23 / $63.59 / $301.33	Professional		$57.23	$63.59	$301.33
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.29 / $33.65 / $49.54	Professional	26	$30.29	$33.65	$49.54
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $26.94 / $29.93 / $196.46	Professional	TC	$26.94	$29.93	$196.46
Cigna Facility/Professional Facility Modifier Low / Median / High Price $113.72 / $113.72 / $113.72	Facility		$113.72	$113.72	$113.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.48 / $91.44 / $219.72	Professional		$46.48	$91.44	$219.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.16 / $36.51 / $69.81	Professional	26	$23.16	$36.51	$69.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.93 / $43.26 / $170.21	Professional	TC	$22.93	$43.26	$170.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $60.76 / $78.34 / $131.13	Professional		$60.76	$78.34	$131.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.16 / $38.10 / $57.02	Professional	26	$30.16	$38.10	$57.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.41 / $39.22 / $65.04	Professional	TC	$30.41	$39.22	$65.04
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $89.05 / $195.20	Professional		$50.12	$89.05	$195.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.75 / $31.57 / $57.77	Professional	26	$24.75	$31.57	$57.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.82 / $45.20 / $187.19	Professional	TC	$22.82	$45.20	$187.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $59.14 / $69.87 / $87.05	Professional		$59.14	$69.87	$87.05
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.54 / $34.90 / $44.18	Professional	26	$29.54	$34.90	$44.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $29.60 / $34.97 / $43.60	Professional	TC	$29.60	$34.97	$43.60