Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.25 / $46.72 / $68.17	Facility	26	$34.25	$46.72	$68.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.62 / $264.08 / $465.80	Professional		$229.62	$264.08	$465.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.26 / $41.49 / $106.76	Professional	26	$34.26	$41.49	$106.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.87 / $221.80 / $421.77	Professional	TC	$192.87	$221.80	$421.77
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $249.44 / $290.45 / $334.02	Professional		$249.44	$290.45	$334.02
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $43.66 / $43.66 / $76.00	Professional	26	$43.66	$43.66	$76.00
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $210.14 / $246.78 / $283.80	Professional	TC	$210.14	$246.78	$283.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $212.83 / $353.61 / $738.97	Professional		$212.83	$353.61	$738.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.74 / $45.14 / $104.85	Professional	26	$30.74	$45.14	$104.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.75 / $308.48 / $634.12	Professional	TC	$181.75	$308.48	$634.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $261.39 / $325.67 / $603.10	Professional		$261.39	$325.67	$603.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.94 / $48.42 / $82.46	Professional	26	$38.94	$48.42	$82.46
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.22 / $272.43 / $518.91	Professional	TC	$223.22	$272.43	$518.91
United Facility/Professional Professional Modifier Low / Median / High Price $181.84 / $299.77 / $617.91	Professional		$181.84	$299.77	$617.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.37 / $38.47 / $74.68	Professional	26	$31.37	$38.47	$74.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.33 / $261.30 / $475.53	Professional	TC	$147.33	$261.30	$475.53
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $208.11 / $220.12 / $390.09	Professional		$208.11	$220.12	$390.09
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.38 / $32.14 / $54.73	Professional	26	$30.38	$32.14	$54.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $177.73 / $187.98 / $331.68	Professional	TC	$177.73	$187.98	$331.68