Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $72.44 / $100.00	Facility	26	$72.44	$72.44	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $346.74 / $1,148.15	Professional		$251.19	$346.74	$1,148.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $102.33 / $281.84	Professional	26	$70.79	$102.33	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $229.09 / $562.34	Professional	TC	$162.18	$229.09	$562.34
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $389.05 / $457.09	Professional		$295.12	$389.05	$457.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $107.15 / $123.03	Professional	26	$93.33	$107.15	$123.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $323.59 / $398.11	Professional	TC	$275.42	$323.59	$398.11
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 $269.15 / $446.68 / $851.14	Professional		$269.15	$446.68	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $97.72 / $181.97	Professional	26	$66.07	$97.72	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $323.59 / $660.69	Professional	TC	$190.55	$323.59	$660.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $371.54 / $512.86	Professional		$316.23	$371.54	$512.86
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 $234.42 / $275.42 / $407.38	Professional	TC	$234.42	$275.42	$407.38
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $389.05 / $676.08	Professional		$263.03	$389.05	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $91.20 / $158.49	Professional	26	$51.29	$91.20	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $295.12 / $537.03	Professional	TC	$194.98	$295.12	$537.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $316.23 / $426.58	Professional		$275.42	$316.23	$426.58
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 $190.55 / $218.78 / $295.12	Professional	TC	$190.55	$218.78	$295.12