Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.50 / $73.50 / $79.36	Facility	26	$73.50	$73.50	$79.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $184.91 / $229.24 / $557.65	Professional		$184.91	$229.24	$557.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.91 / $80.40 / $231.28	Professional	26	$62.91	$80.40	$231.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.34 / $148.83 / $340.52	Professional	TC	$114.34	$148.83	$340.52
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $182.15 / $202.39 / $357.54	Professional		$182.15	$202.39	$357.54
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $59.56 / $66.18 / $183.17	Professional	26	$59.56	$66.18	$183.17
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $122.59 / $136.21 / $198.87	Professional	TC	$122.59	$136.21	$198.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $170.52 / $256.58 / $568.99	Professional		$170.52	$256.58	$568.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.47 / $95.87 / $179.32	Professional	26	$66.47	$95.87	$179.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.22 / $171.76 / $389.01	Professional	TC	$102.22	$171.76	$389.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $188.45 / $239.33 / $343.21	Professional		$188.45	$239.33	$343.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.00 / $85.78 / $114.91	Professional	26	$68.00	$85.78	$114.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.45 / $152.97 / $228.30	Professional	TC	$120.45	$152.97	$228.30
United Facility/Professional Professional Modifier Low / Median / High Price $159.09 / $220.38 / $396.55	Professional		$159.09	$220.38	$396.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.74 / $82.00 / $145.47	Professional	26	$58.74	$82.00	$145.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.46 / $152.77 / $288.20	Professional	TC	$98.46	$152.77	$288.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $188.45 / $216.72 / $269.24	Professional		$188.45	$216.72	$269.24
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.98 / $78.20 / $99.21	Professional	26	$67.98	$78.20	$99.21
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $120.46 / $138.52 / $172.91	Professional	TC	$120.46	$138.52	$172.91