Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $125.89 / $125.89	Facility	26	$120.23	$125.89	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $524.81 / $2,238.72	Professional		$223.87	$524.81	$2,238.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $186.21 / $501.19	Professional	26	$102.33	$186.21	$501.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $436.52 / $1,122.02	Professional	TC	$281.84	$436.52	$1,122.02
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $616.60 / $851.14	Professional		$190.55	$616.60	$851.14
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $141.25 / $162.18	Professional	26	$120.23	$141.25	$162.18
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $467.74 / $588.84	Professional	TC	$416.87	$467.74	$588.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $165.96 / $165.96	Facility	26	$165.96	$165.96	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $676.08 / $1,348.96	Professional		$371.54	$676.08	$1,348.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $120.23 / $213.80	Professional	26	$79.43	$120.23	$213.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $524.81 / $1,148.15	Professional	TC	$288.40	$524.81	$1,148.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $489.78 / $758.58	Professional		$426.58	$489.78	$758.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $114.82 / $154.88	Professional	26	$100.00	$114.82	$154.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $380.19 / $630.96	Professional	TC	$323.59	$380.19	$630.96
United Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $630.96 / $1,122.02	Professional		$398.11	$630.96	$1,122.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $109.65 / $181.97	Professional	26	$61.66	$109.65	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $489.78 / $954.99	Professional	TC	$323.59	$489.78	$954.99
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $501.19 / $676.08	Professional		$426.58	$501.19	$676.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $120.23 / $154.88	Professional	26	$102.33	$120.23	$154.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $380.19 / $524.81	Professional	TC	$331.13	$380.19	$524.81