Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $38.90 / $53.70	Facility	26	$38.90	$38.90	$53.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $263.03 / $1,258.93	Professional		$177.83	$263.03	$1,258.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $61.66 / $186.21	Professional	26	$38.02	$61.66	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $208.93 / $630.96	Professional	TC	$138.04	$208.93	$630.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $208.93 / $269.15	Professional		$47.86	$208.93	$269.15
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $48.98 / $64.57	Professional	26	$42.66	$48.98	$64.57
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $186.21 / $239.88	Professional	TC	$165.96	$186.21	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $257.04 / $467.74	Professional		$165.96	$257.04	$467.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $51.29 / $91.20	Professional	26	$35.48	$51.29	$91.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $218.78 / $457.09	Professional	TC	$131.83	$218.78	$457.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $426.58	Professional		$208.93	$257.04	$426.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $52.48 / $83.18	Professional	26	$43.65	$52.48	$83.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $208.93 / $346.74	Professional	TC	$165.96	$208.93	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $245.47 / $478.63	Professional		$190.55	$245.47	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $45.71 / $95.50	Professional	26	$36.31	$45.71	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $199.53 / $380.19	Professional	TC	$154.88	$199.53	$380.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $346.74	Professional		$208.93	$257.04	$346.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $53.70 / $69.18	Professional	26	$44.67	$53.70	$69.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $199.53 / $275.42	Professional	TC	$165.96	$199.53	$275.42