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 $400.00 / $475.00 / $1,459.50	Professional		$400.00	$475.00	$1,459.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.12 / $126.00 / $239.06	Professional	26	$86.12	$126.00	$239.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $335.00 / $916.49	Professional	TC	$281.41	$335.00	$916.49
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $476.11 / $573.05 / $655.02	Professional		$476.11	$573.05	$655.02
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $86.17 / $96.20 / $109.96	Professional	26	$86.17	$96.20	$109.96
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $389.94 / $476.86 / $542.72	Professional	TC	$389.94	$476.86	$542.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $304.24 / $576.28 / $951.01	Professional		$304.24	$576.28	$951.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.20 / $99.97 / $195.63	Professional	26	$66.20	$99.97	$195.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $235.97 / $450.90 / $728.66	Professional	TC	$235.97	$450.90	$728.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $356.83 / $460.31 / $778.34	Professional		$356.83	$460.31	$778.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.23 / $102.71 / $154.07	Professional	26	$84.23	$102.71	$154.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $271.24 / $349.90 / $599.12	Professional	TC	$271.24	$349.90	$599.12
United Facility/Professional Professional Modifier Low / Median / High Price $306.68 / $450.72 / $920.30	Professional		$306.68	$450.72	$920.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.90 / $87.47 / $188.56	Professional	26	$40.90	$87.47	$188.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $238.54 / $379.28 / $726.75	Professional	TC	$238.54	$379.28	$726.75
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $285.45 / $389.17 / $505.92	Professional		$285.45	$389.17	$505.92
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $68.47 / $89.61 / $116.49	Professional	26	$68.47	$89.61	$116.49
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $216.99 / $299.56 / $382.95	Professional	TC	$216.99	$299.56	$382.95