Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.14 / $88.62 / $318.52	Facility	26	$35.14	$88.62	$318.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.96 / $199.31 / $333.20	Professional		$183.96	$199.31	$333.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.46 / $35.14 / $57.26	Professional	26	$21.46	$35.14	$57.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.49 / $164.16 / $275.93	Professional	TC	$162.49	$164.16	$275.93
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $178.32 / $202.14 / $663.46	Professional		$178.32	$202.14	$663.46
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $23.07 / $34.78 / $40.78	Professional	26	$23.07	$34.78	$40.78
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $155.25 / $167.36 / $191.23	Professional	TC	$155.25	$167.36	$191.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.13 / $291.43 / $623.66	Professional		$192.13	$291.43	$623.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.77 / $41.09 / $107.39	Professional	26	$24.77	$41.09	$107.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.54 / $245.16 / $555.99	Professional	TC	$162.54	$245.16	$555.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $205.05 / $246.30 / $471.61	Professional		$205.05	$246.30	$471.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.08 / $43.60 / $82.89	Professional	26	$38.08	$43.60	$82.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $166.98 / $202.70 / $388.71	Professional	TC	$166.98	$202.70	$388.71
United Facility/Professional Professional Modifier Low / Median / High Price $183.38 / $267.54 / $597.22	Professional		$183.38	$267.54	$597.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.51 / $52.67 / $107.72	Professional	26	$20.51	$52.67	$107.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.38 / $223.58 / $492.25	Professional	TC	$148.38	$223.58	$492.25