Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.00 / $126.00 / $126.00	Facility	26	$126.00	$126.00	$126.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $340.03 / $425.00 / $1,719.73	Professional		$340.03	$425.00	$1,719.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.75 / $126.00 / $196.07	Professional	26	$78.75	$126.00	$196.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.49 / $299.00 / $889.06	Professional	TC	$239.49	$299.00	$889.06
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $404.33 / $449.25 / $537.50	Professional		$404.33	$449.25	$537.50
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $74.66 / $79.81 / $91.22	Professional	26	$74.66	$79.81	$91.22
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $332.50 / $369.44 / $451.00	Professional	TC	$332.50	$369.44	$451.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $237.49 / $465.79 / $742.73	Professional		$237.49	$465.79	$742.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.09 / $82.84 / $159.22	Professional	26	$54.09	$82.84	$159.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $180.92 / $357.96 / $606.41	Professional	TC	$180.92	$357.96	$606.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.88 / $355.89 / $601.52	Professional		$275.88	$355.89	$601.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.90 / $83.92 / $121.65	Professional	26	$68.90	$83.92	$121.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $205.95 / $265.68 / $454.92	Professional	TC	$205.95	$265.68	$454.92
United Facility/Professional Professional Modifier Low / Median / High Price $250.61 / $364.57 / $658.13	Professional		$250.61	$364.57	$658.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.99 / $79.91 / $174.77	Professional	26	$36.99	$79.91	$174.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $193.44 / $284.95 / $572.07	Professional	TC	$193.44	$284.95	$572.07
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $220.70 / $300.76 / $390.99	Professional		$220.70	$300.76	$390.99
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $55.94 / $73.30 / $95.29	Professional	26	$55.94	$73.30	$95.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $164.76 / $227.46 / $290.79	Professional	TC	$164.76	$227.46	$290.79