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 / $151.36	Facility	26	$125.89	$125.89	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $691.83 / $3,090.30	Professional		$398.11	$691.83	$3,090.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $190.55 / $389.05	Professional	26	$107.15	$190.55	$389.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $446.68 / $1,148.15	Professional	TC	$281.84	$446.68	$1,148.15
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $691.83 / $851.14	Professional		$501.19	$691.83	$851.14
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $144.54 / $162.18	Professional	26	$109.65	$144.54	$162.18
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $549.54 / $660.69	Professional	TC	$489.78	$549.54	$660.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $173.78 / $173.78	Facility	26	$173.78	$173.78	$173.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $776.25 / $1,412.54	Professional		$426.58	$776.25	$1,412.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $125.89 / $223.87	Professional	26	$83.18	$125.89	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $616.60 / $1,230.27	Professional	TC	$331.13	$616.60	$1,230.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $562.34 / $758.58	Professional		$489.78	$562.34	$758.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $117.49 / $162.18	Professional	26	$104.71	$117.49	$162.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $446.68 / $630.96	Professional	TC	$380.19	$446.68	$630.96
United Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $707.95 / $1,230.27	Professional		$457.09	$707.95	$1,230.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $114.82 / $186.21	Professional	26	$64.57	$114.82	$186.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $588.84 / $1,047.13	Professional	TC	$371.54	$588.84	$1,047.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $562.34 / $776.25	Professional		$489.78	$562.34	$776.25
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $123.03 / $162.18	Professional	26	$107.15	$123.03	$162.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $436.52 / $602.56	Professional	TC	$380.19	$436.52	$602.56