Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.69 / $104.43 / $152.61	Facility	26	$76.69	$104.43	$152.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $235.61 / $317.30 / $731.13	Professional		$235.61	$317.30	$731.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.69 / $93.67 / $262.77	Professional	26	$76.69	$93.67	$262.77
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $517.65 / $1,043.29 / $1,096.79	Professional	50	$517.65	$1,043.29	$1,096.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.91 / $220.00 / $565.09	Professional	TC	$158.91	$220.00	$565.09
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $416.62 / $434.15 / $496.24	Professional		$416.62	$434.15	$496.24
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $77.00 / $98.98 / $115.36	Professional	26	$77.00	$98.98	$115.36
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $312.79 / $335.17 / $383.10	Professional	TC	$312.79	$335.17	$383.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $289.32 / $531.60 / $905.74	Professional		$289.32	$531.60	$905.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.56 / $105.56 / $206.58	Professional	26	$69.56	$105.56	$206.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $217.22 / $393.79 / $670.84	Professional	TC	$217.22	$393.79	$670.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $340.25 / $438.92 / $620.21	Professional		$340.25	$438.92	$620.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $88.54 / $103.61 / $145.82	Professional	26	$88.54	$103.61	$145.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $250.31 / $322.89 / $474.37	Professional	TC	$250.31	$322.89	$474.37
United Facility/Professional Professional Modifier Low / Median / High Price $224.68 / $414.38 / $688.58	Professional		$224.68	$414.38	$688.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.48 / $96.00 / $157.16	Professional	26	$45.48	$96.00	$157.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $188.68 / $304.64 / $511.79	Professional	TC	$188.68	$304.64	$511.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $225.55 / $306.23 / $398.10	Professional		$225.55	$306.23	$398.10
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $71.95 / $94.19 / $122.45	Professional	26	$71.95	$94.19	$122.45
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $153.61 / $212.04 / $271.07	Professional	TC	$153.61	$212.04	$271.07