Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.00 / $126.00 / $126.00	Facility	26	$126.00	$126.00	$126.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.23 / $425.00 / $1,365.62	Professional		$371.23	$425.00	$1,365.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $126.00 / $229.65	Professional	26	$85.00	$126.00	$229.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $270.89 / $299.00 / $801.32	Professional	TC	$270.89	$299.00	$801.32
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $535.65 / $551.16 / $630.04	Professional		$535.65	$551.16	$630.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $83.03 / $93.65 / $107.05	Professional	26	$83.03	$93.65	$107.05
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $438.66 / $457.52 / $539.97	Professional	TC	$438.66	$457.52	$539.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $271.75 / $589.97 / $953.21	Professional		$271.75	$589.97	$953.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.49 / $97.16 / $185.75	Professional	26	$63.49	$97.16	$185.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $205.62 / $446.83 / $775.34	Professional	TC	$205.62	$446.83	$775.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $318.02 / $410.26 / $693.40	Professional		$318.02	$410.26	$693.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.92 / $98.51 / $135.03	Professional	26	$80.92	$98.51	$135.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $235.94 / $304.36 / $521.24	Professional	TC	$235.94	$304.36	$521.24
United Facility/Professional Professional Modifier Low / Median / High Price $283.30 / $406.45 / $788.69	Professional		$283.30	$406.45	$788.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.10 / $85.26 / $139.24	Professional	26	$41.10	$85.26	$139.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.52 / $352.99 / $764.04	Professional	TC	$229.52	$352.99	$764.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $254.42 / $346.70 / $450.71	Professional		$254.42	$346.70	$450.71
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $65.67 / $86.08 / $111.90	Professional	26	$65.67	$86.08	$111.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $188.75 / $260.62 / $333.18	Professional	TC	$188.75	$260.62	$333.18