Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $125.89 / $173.78	Facility	26	$79.43	$125.89	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $467.74 / $1,445.44	Professional		$213.80	$467.74	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $125.89 / $316.23	Professional	26	$67.61	$125.89	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $302.00 / $831.76	Professional	TC	$144.54	$302.00	$831.76
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $263.03 / $416.87	Professional		$93.33	$263.03	$416.87
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $85.11 / $125.89	Professional	26	$75.86	$85.11	$125.89
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $194.98 / $263.03	Professional	TC	$173.78	$194.98	$263.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $112.20 / $112.20	Facility	26	$112.20	$112.20	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $398.11 / $707.95	Professional		$173.78	$398.11	$707.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $81.28 / $154.88	Professional	26	$53.70	$81.28	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $281.84 / $575.44	Professional	TC	$117.49	$281.84	$575.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $234.42 / $446.68	Professional		$199.53	$234.42	$446.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $75.86 / $102.33	Professional	26	$67.61	$75.86	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $158.49 / $354.81	Professional	TC	$134.90	$158.49	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $295.12 / $645.65	Professional		$190.55	$295.12	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $74.13 / $125.89	Professional	26	$41.69	$74.13	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $218.78 / $501.19	Professional	TC	$134.90	$218.78	$501.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $234.42 / $323.59	Professional		$204.17	$234.42	$323.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $79.43 / $104.71	Professional	26	$69.18	$79.43	$104.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $158.49 / $218.78	Professional	TC	$134.90	$158.49	$218.78