Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $64.57 / $69.18	Facility	26	$50.12	$64.57	$69.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $398.11 / $1,230.27	Professional		$245.47	$398.11	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $109.65 / $316.23	Professional	26	$52.48	$109.65	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $239.88 / $616.60	Professional	TC	$173.78	$239.88	$616.60
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $269.15 / $354.81	Professional		$51.29	$269.15	$354.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $57.54 / $223.87	Professional	26	$57.54	$57.54	$223.87
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $213.80 / $371.54	Professional	TC	$213.80	$213.80	$371.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Facility	26	$89.13	$89.13	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $389.05 / $630.96	Professional		$263.03	$389.05	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $89.13 / $154.88	Professional	26	$52.48	$89.13	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $302.00 / $512.86	Professional	TC	$199.53	$302.00	$512.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $316.23 / $478.63	Professional		$263.03	$316.23	$478.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $63.10 / $104.71	Professional	26	$53.70	$63.10	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $257.04 / $380.19	Professional	TC	$194.98	$257.04	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $371.54 / $588.84	Professional		$245.47	$371.54	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $83.18 / $128.82	Professional	26	$51.29	$83.18	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $295.12 / $467.74	Professional	TC	$194.98	$295.12	$467.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $346.74 / $407.38	Professional		$223.87	$346.74	$407.38
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $66.07 / $79.43	Professional	26	$45.71	$66.07	$79.43
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $281.84 / $331.13	Professional	TC	$177.83	$281.84	$331.13