Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $91.20 / $181.97	Facility	26	$91.20	$91.20	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $223.87 / $870.96	Professional		$120.23	$223.87	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $204.17 / $380.19	Professional	26	$95.50	$204.17	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $53.70 / $229.09	Professional	TC	$25.70	$53.70	$229.09
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $144.54 / $870.96	Professional		$40.74	$144.54	$870.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $104.71 / $263.03	Professional	26	$102.33	$104.71	$263.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $44.67 / $60.26	Professional	TC	$39.81	$44.67	$60.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $181.97 / $457.09	Professional		$112.20	$181.97	$457.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $128.82 / $281.84	Professional	26	$83.18	$128.82	$281.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $51.29 / $128.82	Professional	TC	$29.51	$51.29	$128.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $177.83 / $263.03	Professional		$147.91	$177.83	$263.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $123.03 / $181.97	Professional	26	$107.15	$123.03	$181.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $48.98 / $104.71	Professional	TC	$40.74	$48.98	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $194.98 / $524.81	Professional		$117.49	$194.98	$524.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $109.65 / $194.98	Professional	26	$77.62	$109.65	$194.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $46.77 / $398.11	Professional	TC	$22.91	$46.77	$398.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $173.78 / $218.78	Professional		$141.25	$173.78	$218.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $125.89 / $162.18	Professional	26	$102.33	$125.89	$162.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $47.86 / $58.88	Professional	TC	$38.02	$47.86	$58.88