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 / $125.89	Facility	26	$125.89	$125.89	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $478.63 / $1,412.54	Professional		$281.84	$478.63	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $151.36 / $398.11	Professional	26	$85.11	$151.36	$398.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $331.13 / $691.83	Professional	TC	$190.55	$331.13	$691.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $363.08 / $467.74	Professional		$117.49	$363.08	$467.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $104.71 / $134.90	Professional	26	$93.33	$104.71	$134.90
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $288.40 / $426.58	Professional	TC	$257.04	$288.40	$426.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $138.04 / $138.04	Facility	26	$138.04	$138.04	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $467.74 / $891.25	Professional		$239.88	$467.74	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $181.97	Professional	26	$66.07	$100.00	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $338.84 / $676.08	Professional	TC	$169.82	$338.84	$676.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $323.59 / $616.60	Professional		$281.84	$323.59	$616.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $93.33 / $128.82	Professional	26	$83.18	$93.33	$128.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $234.42 / $478.63	Professional	TC	$199.53	$234.42	$478.63
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $407.38 / $812.83	Professional		$263.03	$407.38	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $91.20 / $154.88	Professional	26	$51.29	$91.20	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $295.12 / $645.65	Professional	TC	$194.98	$295.12	$645.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $331.13 / $446.68	Professional		$281.84	$331.13	$446.68
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $97.72 / $128.82	Professional	26	$85.11	$97.72	$128.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $229.09 / $323.59	Professional	TC	$199.53	$229.09	$323.59