Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.08 / $224.22 / $428.91	Facility	26	$62.08	$224.22	$428.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.59 / $133.16 / $275.00	Professional		$124.59	$133.16	$275.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.54 / $62.08 / $150.22	Professional	26	$52.54	$62.08	$150.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.51 / $71.09 / $172.03	Professional	TC	$64.51	$71.09	$172.03
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $132.99 / $176.88 / $343.61	Professional		$132.99	$176.88	$343.61
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $55.48 / $59.27 / $89.44	Professional	26	$55.48	$59.27	$89.44
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $73.73 / $98.06 / $288.14	Professional	TC	$73.73	$98.06	$288.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.30 / $305.02 / $572.30	Professional		$111.30	$305.02	$572.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.85 / $79.30 / $262.95	Professional	26	$53.85	$79.30	$262.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.05 / $182.16 / $363.92	Professional	TC	$53.05	$182.16	$363.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $132.16 / $322.47 / $322.47	Professional		$132.16	$322.47	$322.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $151.50 / $151.50	Professional	26	$69.18	$151.50	$151.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $62.99 / $170.97 / $170.97	Professional	TC	$62.99	$170.97	$170.97
United Facility/Professional Professional Modifier Low / Median / High Price $118.46 / $183.82 / $489.46	Professional		$118.46	$183.82	$489.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.72 / $83.41 / $229.95	Professional	26	$47.72	$83.41	$229.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.73 / $89.24 / $259.51	Professional	TC	$70.73	$89.24	$259.51