Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.62 / $126.00 / $151.19	Facility	26	$125.62	$126.00	$151.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.00 / $478.01 / $1,802.25	Professional		$400.00	$478.01	$1,802.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.99 / $138.16 / $299.89	Professional	26	$112.99	$138.16	$299.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $335.00 / $1,020.25	Professional	TC	$281.41	$335.00	$1,020.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $705.12 / $783.47 / $967.58	Professional		$705.12	$783.47	$967.58
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $108.15 / $121.56 / $138.94	Professional	26	$108.15	$121.56	$138.94
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $586.96 / $661.91 / $859.43	Professional	TC	$586.96	$661.91	$859.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $425.28 / $831.68 / $1,405.49	Professional		$425.28	$831.68	$1,405.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.78 / $127.52 / $241.96	Professional	26	$83.78	$127.52	$241.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $338.17 / $675.83 / $1,238.07	Professional	TC	$338.17	$675.83	$1,238.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $494.62 / $638.05 / $1,080.42	Professional		$494.62	$638.05	$1,080.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $106.61 / $129.29 / $175.28	Professional	26	$106.61	$129.29	$175.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $386.30 / $498.33 / $853.60	Professional	TC	$386.30	$498.33	$853.60
United Facility/Professional Professional Modifier Low / Median / High Price $458.30 / $656.67 / $1,207.56	Professional		$458.30	$656.67	$1,207.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.88 / $114.76 / $219.18	Professional	26	$56.88	$114.76	$219.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $365.53 / $588.29 / $1,184.36	Professional	TC	$365.53	$588.29	$1,184.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $394.86 / $539.04 / $700.77	Professional		$394.86	$539.04	$700.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $86.65 / $113.41 / $147.43	Professional	26	$86.65	$113.41	$147.43
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $308.20 / $425.64 / $544.14	Professional	TC	$308.20	$425.64	$544.14