Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Facility	26	$125.89	$125.89	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $478.63 / $1,737.80	Professional		$275.42	$478.63	$1,737.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $141.25 / $354.81	Professional	26	$72.44	$141.25	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $338.84 / $812.83	Professional	TC	$204.17	$338.84	$812.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $389.05 / $446.68	Professional		$109.65	$389.05	$446.68
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $91.20 / $97.72	Professional	26	$85.11	$91.20	$97.72
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $295.12 / $371.54	Professional	TC	$263.03	$295.12	$371.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $112.20 / $112.20	Facility	26	$112.20	$112.20	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $446.68 / $794.33	Professional		$239.88	$446.68	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $81.28 / $151.36	Professional	26	$53.70	$81.28	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $331.13 / $630.96	Professional	TC	$181.97	$331.13	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $316.23 / $489.78	Professional		$269.15	$316.23	$489.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $75.86 / $104.71	Professional	26	$67.61	$75.86	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $239.88 / $407.38	Professional	TC	$204.17	$239.88	$407.38
United Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $380.19 / $676.08	Professional		$251.19	$380.19	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $75.86 / $128.82	Professional	26	$42.66	$75.86	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $302.00 / $575.44	Professional	TC	$194.98	$302.00	$575.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $316.23 / $436.52	Professional		$275.42	$316.23	$436.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $79.43 / $104.71	Professional	26	$69.18	$79.43	$104.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $239.88 / $331.13	Professional	TC	$204.17	$239.88	$331.13