Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $93.33 / $151.36	Facility	26	$75.86	$93.33	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $316.23 / $724.44	Professional		$204.17	$316.23	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $165.96 / $416.87	Professional	26	$79.43	$165.96	$416.87
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $512.86 / $1,047.13 / $1,096.48	Professional	50	$512.86	$1,047.13	$1,096.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $239.88 / $562.34	Professional	TC	$169.82	$239.88	$562.34
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $416.87 / $478.63	Professional		$316.23	$416.87	$478.63
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $112.20 / $123.03	Professional	26	$97.72	$112.20	$123.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $338.84 / $467.74	Professional	TC	$295.12	$338.84	$467.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $144.54 / $144.54 / $144.54	Facility	26	$144.54	$144.54	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $457.09 / $891.25	Professional		$275.42	$457.09	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $100.00 / $190.55	Professional	26	$69.18	$100.00	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $338.84 / $676.08	Professional	TC	$199.53	$338.84	$676.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $389.05 / $524.81	Professional		$331.13	$389.05	$524.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $100.00 / $134.90	Professional	26	$87.10	$100.00	$134.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $288.40 / $407.38	Professional	TC	$251.19	$288.40	$407.38
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $426.58 / $707.95	Professional		$275.42	$426.58	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $95.50 / $165.96	Professional	26	$53.70	$95.50	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $323.59 / $562.34	Professional	TC	$213.80	$323.59	$562.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $323.59 / $436.52	Professional		$281.84	$323.59	$436.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $104.71 / $134.90	Professional	26	$89.13	$104.71	$134.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $218.78 / $295.12	Professional	TC	$190.55	$218.78	$295.12