Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	26	$52.48	$52.48	$52.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $302.00 / $707.95	Professional		$204.17	$302.00	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $208.93	Professional	26	$52.48	$72.44	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $239.88 / $537.03	Professional	TC	$147.91	$239.88	$537.03
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $275.42 / $354.81	Professional		$79.43	$275.42	$354.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $72.44 / $91.20	Professional	26	$45.71	$72.44	$91.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $229.09 / $263.03	Professional	TC	$181.97	$229.09	$263.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $288.40 / $630.96	Professional		$177.83	$288.40	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $72.44 / $162.18	Professional	26	$47.86	$72.44	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $229.09 / $524.81	Professional	TC	$125.89	$229.09	$524.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $269.15 / $524.81	Professional		$223.87	$269.15	$524.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $69.18 / $104.71	Professional	26	$60.26	$69.18	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $199.53 / $416.87	Professional	TC	$165.96	$199.53	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $309.03 / $630.96	Professional		$204.17	$309.03	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $64.57 / $117.49	Professional	26	$28.18	$64.57	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $223.87 / $562.34	Professional	TC	$151.36	$223.87	$562.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $269.15 / $363.08	Professional		$223.87	$269.15	$363.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $72.44 / $93.33	Professional	26	$60.26	$72.44	$93.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $199.53 / $275.42	Professional	TC	$162.18	$199.53	$275.42