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 / $126.00	Facility	26	$126.00	$126.00	$126.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $345.57 / $425.00 / $1,365.49	Professional		$345.57	$425.00	$1,365.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $126.00 / $229.65	Professional	26	$85.00	$126.00	$229.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.10 / $299.00 / $872.72	Professional	TC	$229.10	$299.00	$872.72
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $468.98 / $482.53 / $612.80	Professional		$468.98	$482.53	$612.80
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $83.03 / $93.65 / $118.94	Professional	26	$83.03	$93.65	$118.94
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $371.98 / $388.88 / $496.07	Professional	TC	$371.98	$388.88	$496.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $240.50 / $531.73 / $863.56	Professional		$240.50	$531.73	$863.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.49 / $97.33 / $185.75	Professional	26	$63.49	$97.33	$185.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $174.37 / $379.36 / $684.94	Professional	TC	$174.37	$379.36	$684.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $282.45 / $364.37 / $620.37	Professional		$282.45	$364.37	$620.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.92 / $98.51 / $135.65	Professional	26	$80.92	$98.51	$135.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $200.38 / $258.49 / $521.03	Professional	TC	$200.38	$258.49	$521.03
United Facility/Professional Professional Modifier Low / Median / High Price $260.85 / $410.29 / $849.01	Professional		$260.85	$410.29	$849.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.39 / $93.59 / $174.89	Professional	26	$43.39	$93.59	$174.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.65 / $291.99 / $641.66	Professional	TC	$194.65	$291.99	$641.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $225.97 / $307.37 / $399.58	Professional		$225.97	$307.37	$399.58
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $65.67 / $86.08 / $111.90	Professional	26	$65.67	$86.08	$111.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $160.30 / $221.29 / $282.89	Professional	TC	$160.30	$221.29	$282.89