Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.08 / $80.86 / $119.55	Facility	26	$60.08	$80.86	$119.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.59 / $163.04 / $727.00	Professional		$124.59	$163.04	$727.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.54 / $73.39 / $292.00	Professional	26	$52.54	$73.39	$292.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.51 / $107.99 / $425.50	Professional	TC	$64.51	$107.99	$425.50
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $132.99 / $144.96 / $343.61	Professional		$132.99	$144.96	$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 / $80.37 / $288.14	Professional	TC	$73.73	$80.37	$288.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.22 / $177.96 / $394.44	Professional		$102.22	$177.96	$394.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.39 / $74.29 / $160.55	Professional	26	$49.39	$74.29	$160.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.62 / $98.97 / $254.90	Professional	TC	$46.62	$98.97	$254.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $129.66 / $167.27 / $309.02	Professional		$129.66	$167.27	$309.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.90 / $83.53 / $144.44	Professional	26	$61.90	$83.53	$144.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.05 / $77.45 / $164.58	Professional	TC	$60.05	$77.45	$164.58
United Facility/Professional Professional Modifier Low / Median / High Price $107.49 / $169.11 / $307.48	Professional		$107.49	$169.11	$307.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.15 / $66.73 / $124.29	Professional	26	$31.15	$66.73	$124.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.26 / $98.92 / $201.42	Professional	TC	$66.26	$98.92	$201.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $121.89 / $148.69 / $185.87	Professional		$121.89	$148.69	$185.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $65.43 / $80.05 / $101.09	Professional	26	$65.43	$80.05	$101.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $56.45 / $67.81 / $84.77	Professional	TC	$56.45	$67.81	$84.77