Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $165.96 / $229.09	Facility	26	$165.96	$165.96	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $338.84 / $870.96	Professional		$263.03	$338.84	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $204.17 / $537.03	Professional	26	$169.82	$204.17	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $114.82 / $186.21	Professional	TC	$93.33	$114.82	$186.21
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $251.19 / $346.74	Professional		$112.20	$251.19	$346.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $169.82 / $446.68	Professional	26	$169.82	$169.82	$446.68
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $102.33 / $158.49	Professional	TC	$102.33	$102.33	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $398.11 / $707.95	Professional		$263.03	$398.11	$707.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $239.88 / $436.52	Professional	26	$169.82	$239.88	$436.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $154.88 / $281.84	Professional	TC	$95.50	$154.88	$281.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $338.84 / $478.63	Professional		$239.88	$338.84	$478.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $204.17 / $295.12	Professional	26	$147.91	$204.17	$295.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $131.83 / $181.97	Professional	TC	$91.20	$131.83	$181.97
United Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $371.54 / $630.96	Professional		$251.19	$371.54	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $223.87 / $389.05	Professional	26	$151.36	$223.87	$389.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $144.54 / $239.88	Professional	TC	$100.00	$144.54	$239.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $363.08 / $457.09	Professional		$257.04	$363.08	$457.09
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $223.87 / $281.84	Professional	26	$165.96	$223.87	$281.84
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $138.04 / $169.82	Professional	TC	$93.33	$138.04	$169.82