Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $128.82 / $173.78	Facility	26	$125.89	$128.82	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $562.34 / $2,089.30	Professional		$338.84	$562.34	$2,089.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $204.17 / $524.81	Professional	26	$102.33	$204.17	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $346.74 / $891.25	Professional	TC	$223.87	$346.74	$891.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $426.58 / $549.54	Professional		$134.90	$426.58	$549.54
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $144.54 / $194.98	Professional	26	$123.03	$144.54	$194.98
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $323.59 / $954.99	Professional	TC	$288.40	$323.59	$954.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $177.83 / $177.83	Facility	26	$177.83	$177.83	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $549.54 / $1,258.93	Professional		$281.84	$549.54	$1,258.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $128.82 / $245.47	Professional	26	$83.18	$128.82	$245.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $380.19 / $1,096.48	Professional	TC	$194.98	$380.19	$1,096.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $380.19 / $724.44	Professional		$331.13	$380.19	$724.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $120.23 / $165.96	Professional	26	$107.15	$120.23	$165.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $263.03 / $549.54	Professional	TC	$223.87	$263.03	$549.54
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $489.78 / $1,071.52	Professional		$323.59	$489.78	$1,071.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $117.49 / $199.53	Professional	26	$67.61	$117.49	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $371.54 / $831.76	Professional	TC	$223.87	$371.54	$831.76
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $389.05 / $524.81	Professional		$338.84	$389.05	$524.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $125.89 / $165.96	Professional	26	$109.65	$125.89	$165.96
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $263.03 / $363.08	Professional	TC	$223.87	$263.03	$363.08