Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.38 / $56.85 / $67.31	Facility	26	$47.38	$56.85	$67.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $153.55 / $165.99 / $316.93	Professional		$153.55	$165.99	$316.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.38 / $51.54 / $140.03	Professional	26	$47.38	$51.54	$140.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $106.17 / $116.85 / $212.34	Professional	TC	$106.17	$116.85	$212.34
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $177.68 / $193.83 / $258.79	Professional		$177.68	$193.83	$258.79
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $61.03 / $61.03 / $66.52	Professional	26	$61.03	$61.03	$66.52
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $116.65 / $131.38 / $193.28	Professional	TC	$116.65	$131.38	$193.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $140.90 / $214.15 / $477.88	Professional		$140.90	$214.15	$477.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.94 / $63.48 / $146.46	Professional	26	$42.94	$63.48	$146.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.60 / $150.66 / $331.42	Professional	TC	$97.60	$150.66	$331.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.05 / $213.67 / $378.96	Professional		$173.05	$213.67	$378.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.33 / $67.48 / $115.41	Professional	26	$54.33	$67.48	$115.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $119.87 / $150.29 / $278.32	Professional	TC	$119.87	$150.29	$278.32
United Facility/Professional Professional Modifier Low / Median / High Price $146.09 / $197.22 / $324.83	Professional		$146.09	$197.22	$324.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.91 / $53.53 / $102.76	Professional	26	$43.91	$53.53	$102.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.87 / $129.76 / $212.80	Professional	TC	$97.87	$129.76	$212.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $145.72 / $162.52 / $257.19	Professional		$145.72	$162.52	$257.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.79 / $49.96 / $76.28	Professional	26	$44.79	$49.96	$76.28
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $100.94 / $112.58 / $177.87	Professional	TC	$100.94	$112.58	$177.87