Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.56 / $111.13 / $162.34	Facility	26	$81.56	$111.13	$162.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $315.32 / $434.02 / $1,618.00	Professional		$315.32	$434.02	$1,618.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.58 / $105.72 / $326.39	Professional	26	$81.58	$105.72	$326.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $233.74 / $315.29 / $626.41	Professional	TC	$233.74	$315.29	$626.41
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $446.25 / $495.84 / $651.52	Professional		$446.25	$495.84	$651.52
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $105.35 / $105.35 / $136.94	Professional	26	$105.35	$105.35	$136.94
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $351.44 / $390.49 / $513.10	Professional	TC	$351.44	$390.49	$513.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $303.72 / $505.45 / $954.56	Professional		$303.72	$505.45	$954.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.98 / $114.25 / $219.81	Professional	26	$73.98	$114.25	$219.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $226.55 / $387.13 / $704.60	Professional	TC	$226.55	$387.13	$704.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $354.62 / $446.05 / $654.29	Professional		$354.62	$446.05	$654.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $94.24 / $115.30 / $208.05	Professional	26	$94.24	$115.30	$208.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $258.85 / $330.75 / $652.44	Professional	TC	$258.85	$330.75	$652.44
United Facility/Professional Professional Modifier Low / Median / High Price $244.49 / $410.88 / $712.32	Professional		$244.49	$410.88	$712.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.15 / $107.37 / $233.75	Professional	26	$54.15	$107.37	$233.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $193.00 / $296.93 / $489.32	Professional	TC	$193.00	$296.93	$489.32
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $284.81 / $387.87 / $504.23	Professional		$284.81	$387.87	$504.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $76.53 / $100.26 / $130.34	Professional	26	$76.53	$100.26	$130.34
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $208.28 / $287.61 / $367.68	Professional	TC	$208.28	$287.61	$367.68