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 $290.37 / $425.00 / $1,242.61	Professional		$290.37	$425.00	$1,242.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.29 / $126.00 / $286.98	Professional	26	$69.29	$126.00	$286.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $217.41 / $329.66 / $894.40	Professional	TC	$217.41	$329.66	$894.40
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $405.68 / $413.32 / $524.91	Professional		$405.68	$413.32	$524.91
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $57.22 / $64.87 / $74.14	Professional	26	$57.22	$64.87	$74.14
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $338.34 / $348.45 / $443.45	Professional	TC	$338.34	$348.45	$443.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.51 / $469.02 / $809.31	Professional		$204.51	$469.02	$809.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.86 / $67.19 / $135.00	Professional	26	$43.86	$67.19	$135.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $158.60 / $360.40 / $664.83	Professional	TC	$158.60	$360.40	$664.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.99 / $309.58 / $589.58	Professional		$239.99	$309.58	$589.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.93 / $68.04 / $99.90	Professional	26	$55.93	$68.04	$99.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $183.29 / $236.44 / $473.66	Professional	TC	$183.29	$236.44	$473.66
United Facility/Professional Professional Modifier Low / Median / High Price $217.29 / $312.25 / $688.72	Professional		$217.29	$312.25	$688.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.93 / $64.65 / $103.70	Professional	26	$29.93	$64.65	$103.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $174.31 / $261.47 / $660.08	Professional	TC	$174.31	$261.47	$660.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $191.99 / $261.89 / $340.47	Professional		$191.99	$261.89	$340.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.36 / $59.50 / $77.34	Professional	26	$45.36	$59.50	$77.34
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $146.63 / $202.40 / $258.74	Professional	TC	$146.63	$202.40	$258.74