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 $307.52 / $475.00 / $1,160.82	Professional		$307.52	$475.00	$1,160.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.56 / $126.00 / $200.20	Professional	26	$71.56	$126.00	$200.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $208.03 / $335.00 / $801.32	Professional	TC	$208.03	$335.00	$801.32
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $398.88 / $409.17 / $519.65	Professional		$398.88	$409.17	$519.65
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $64.53 / $72.91 / $92.60	Professional	26	$64.53	$72.91	$92.60
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $323.12 / $336.26 / $427.05	Professional	TC	$323.12	$336.26	$427.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $203.11 / $461.19 / $754.63	Professional		$203.11	$461.19	$754.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.36 / $74.84 / $147.83	Professional	26	$49.36	$74.84	$147.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.46 / $341.44 / $606.40	Professional	TC	$151.46	$341.44	$606.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $237.62 / $306.52 / $517.86	Professional		$237.62	$306.52	$517.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.91 / $76.58 / $103.83	Professional	26	$62.91	$76.58	$103.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.80 / $224.20 / $409.21	Professional	TC	$173.80	$224.20	$409.21
United Facility/Professional Professional Modifier Low / Median / High Price $220.65 / $315.22 / $782.96	Professional		$220.65	$315.22	$782.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.29 / $72.18 / $142.10	Professional	26	$38.29	$72.18	$142.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $167.82 / $244.35 / $632.38	Professional	TC	$167.82	$244.35	$632.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $190.10 / $258.93 / $336.61	Professional		$190.10	$258.93	$336.61
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.06 / $66.93 / $87.01	Professional	26	$51.06	$66.93	$87.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $139.04 / $192.00 / $245.46	Professional	TC	$139.04	$192.00	$245.46