Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $87.10 / $97.72	Facility	26	$70.79	$87.10	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $436.52 / $1,698.24	Professional		$251.19	$436.52	$1,698.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $95.50 / $288.40	Professional	26	$75.86	$95.50	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $239.88 / $645.65	Professional	TC	$165.96	$239.88	$645.65
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $371.54 / $446.68	Professional		$251.19	$371.54	$446.68
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $107.15 / $120.23	Professional	26	$83.18	$107.15	$120.23
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $288.40 / $323.59	Professional	TC	$257.04	$288.40	$323.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $134.90 / $134.90	Facility	26	$134.90	$134.90	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $446.68 / $851.14	Professional		$239.88	$446.68	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $95.50 / $186.21	Professional	26	$64.57	$95.50	$186.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $323.59 / $660.69	Professional	TC	$173.78	$323.59	$660.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $331.13 / $501.19	Professional		$281.84	$331.13	$501.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $91.20 / $125.89	Professional	26	$81.28	$91.20	$125.89
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 / $758.58	Professional		$251.19	$380.19	$758.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $89.13 / $154.88	Professional	26	$50.12	$89.13	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $275.42 / $616.60	Professional	TC	$186.21	$275.42	$616.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $316.23 / $426.58	Professional		$275.42	$316.23	$426.58
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $95.50 / $125.89	Professional	26	$83.18	$95.50	$125.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $223.87 / $295.12	Professional	TC	$190.55	$223.87	$295.12