Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $89.13 / $100.00	Facility	26	$74.13	$89.13	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $371.54 / $1,513.56	Professional		$251.19	$371.54	$1,513.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $128.82 / $295.12	Professional	26	$75.86	$128.82	$295.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $229.09 / $562.34	Professional	TC	$169.82	$229.09	$562.34
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $398.11 / $478.63	Professional		$100.00	$398.11	$478.63
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $112.20 / $123.03	Professional	26	$77.62	$112.20	$123.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $323.59 / $380.19	Professional	TC	$295.12	$323.59	$380.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $141.25 / $141.25	Facility	26	$141.25	$141.25	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $446.68 / $851.14	Professional		$269.15	$446.68	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $190.55	Professional	26	$66.07	$100.00	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $331.13 / $660.69	Professional	TC	$190.55	$331.13	$660.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $371.54 / $512.86	Professional		$316.23	$371.54	$512.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $95.50 / $128.82	Professional	26	$83.18	$95.50	$128.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $275.42 / $407.38	Professional	TC	$234.42	$275.42	$407.38
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $398.11 / $691.83	Professional		$263.03	$398.11	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $93.33 / $158.49	Professional	26	$53.70	$93.33	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $309.03 / $562.34	Professional	TC	$199.53	$309.03	$562.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $323.59 / $426.58	Professional		$275.42	$323.59	$426.58
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $100.00 / $128.82	Professional	26	$87.10	$100.00	$128.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $218.78 / $295.12	Professional	TC	$190.55	$218.78	$295.12