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 / $162.46	Facility	26	$126.00	$126.00	$162.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $337.32 / $425.00 / $1,389.90	Professional		$337.32	$425.00	$1,389.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.49 / $126.00 / $254.79	Professional	26	$85.49	$126.00	$254.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $233.34 / $299.00 / $1,005.38	Professional	TC	$233.34	$299.00	$1,005.38
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $415.00 / $456.98 / $561.48	Professional		$415.00	$456.98	$561.48
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $90.99 / $96.76 / $117.08	Professional	26	$90.99	$96.76	$117.08
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $324.17 / $360.19 / $469.01	Professional	TC	$324.17	$360.19	$469.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $246.87 / $530.94 / $895.56	Professional		$246.87	$530.94	$895.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.50 / $104.06 / $199.60	Professional	26	$66.50	$104.06	$199.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.94 / $381.47 / $688.46	Professional	TC	$177.94	$381.47	$688.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $289.83 / $373.89 / $630.87	Professional		$289.83	$373.89	$630.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.68 / $103.18 / $162.86	Professional	26	$84.68	$103.18	$162.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $203.86 / $262.98 / $521.03	Professional	TC	$203.86	$262.98	$521.03
United Facility/Professional Professional Modifier Low / Median / High Price $266.33 / $416.62 / $917.38	Professional		$266.33	$416.62	$917.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.97 / $89.57 / $168.69	Professional	26	$47.97	$89.57	$168.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $197.99 / $296.98 / $621.83	Professional	TC	$197.99	$296.98	$621.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $231.87 / $315.23 / $409.80	Professional		$231.87	$315.23	$409.80
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $68.78 / $90.08 / $117.10	Professional	26	$68.78	$90.08	$117.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $163.09 / $225.15 / $287.82	Professional	TC	$163.09	$225.15	$287.82