Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $151.36 / $173.78	Facility	26	$125.89	$151.36	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $478.63 / $1,584.89	Professional		$269.15	$478.63	$1,584.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $125.89 / $302.00	Professional	26	$72.44	$125.89	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $309.03 / $691.83	Professional	TC	$186.21	$309.03	$691.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $371.54 / $446.68	Professional		$263.03	$371.54	$446.68
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $91.20 / $102.33	Professional	26	$57.54	$91.20	$102.33
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $269.15 / $354.81	Professional	TC	$239.88	$269.15	$354.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $467.74 / $812.83	Professional		$218.78	$467.74	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $74.13 / $151.36	Professional	26	$50.12	$74.13	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $354.81 / $660.69	Professional	TC	$158.49	$354.81	$660.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $295.12 / $562.34	Professional		$257.04	$295.12	$562.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $79.43 / $107.15	Professional	26	$67.61	$79.43	$107.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $218.78 / $478.63	Professional	TC	$186.21	$218.78	$478.63
United Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $363.08 / $724.44	Professional		$234.42	$363.08	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $69.18 / $125.89	Professional	26	$33.88	$69.18	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $269.15 / $630.96	Professional	TC	$177.83	$269.15	$630.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $302.00 / $407.38	Professional		$257.04	$302.00	$407.38
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $81.28 / $107.15	Professional	26	$70.79	$81.28	$107.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $218.78 / $302.00	Professional	TC	$186.21	$218.78	$302.00