Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $47.86 / $95.50	Facility	26	$47.86	$47.86	$95.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $363.08 / $794.33	Professional		$269.15	$363.08	$794.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $66.07 / $181.97	Professional	26	$42.66	$66.07	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $316.23 / $933.25	Professional	TC	$223.87	$316.23	$933.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $309.03 / $363.08	Professional		$52.48	$309.03	$363.08
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $57.54 / $67.61	Professional	26	$52.48	$57.54	$67.61
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $302.00 / $346.74	Professional	TC	$269.15	$302.00	$346.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $398.11 / $724.44	Professional		$251.19	$398.11	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $63.10 / $109.65	Professional	26	$42.66	$63.10	$109.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $354.81 / $724.44	Professional	TC	$208.93	$354.81	$724.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $380.19 / $724.44	Professional		$316.23	$380.19	$724.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $61.66 / $114.82	Professional	26	$53.70	$61.66	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $309.03 / $602.56	Professional	TC	$257.04	$309.03	$602.56
United Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $363.08 / $741.31	Professional		$288.40	$363.08	$741.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $54.95 / $114.82	Professional	26	$43.65	$54.95	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $309.03 / $630.96	Professional	TC	$245.47	$309.03	$630.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $380.19 / $524.81	Professional		$316.23	$380.19	$524.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $64.57 / $85.11	Professional	26	$53.70	$64.57	$85.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $316.23 / $436.52	Professional	TC	$263.03	$316.23	$436.52