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 / $142.94	Facility	26	$126.00	$126.00	$142.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.00 / $475.00 / $1,805.54	Professional		$400.00	$475.00	$1,805.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $118.59 / $140.00 / $361.37	Professional	26	$118.59	$140.00	$361.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $335.00 / $874.18	Professional	TC	$281.41	$335.00	$874.18
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $541.20 / $601.34 / $882.59	Professional		$541.20	$601.34	$882.59
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $130.16 / $138.66 / $158.47	Professional	26	$130.16	$138.66	$158.47
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $416.41 / $462.68 / $738.28	Professional	TC	$416.41	$462.68	$738.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $325.77 / $617.39 / $1,018.85	Professional		$325.77	$617.39	$1,018.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.51 / $143.94 / $276.57	Professional	26	$94.51	$143.94	$276.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $226.83 / $440.24 / $782.39	Professional	TC	$226.83	$440.24	$782.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $378.76 / $488.60 / $724.24	Professional		$378.76	$488.60	$724.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $121.17 / $147.53 / $200.59	Professional	26	$121.17	$147.53	$200.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $255.82 / $330.01 / $568.02	Professional	TC	$255.82	$330.01	$568.02
United Facility/Professional Professional Modifier Low / Median / High Price $299.95 / $480.20 / $837.83	Professional		$299.95	$480.20	$837.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.77 / $130.28 / $213.17	Professional	26	$67.77	$130.28	$213.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.85 / $382.12 / $944.21	Professional	TC	$251.85	$382.12	$944.21
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $303.01 / $411.50 / $534.95	Professional		$303.01	$411.50	$534.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $98.35 / $128.90 / $167.57	Professional	26	$98.35	$128.90	$167.57
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $204.66 / $282.60 / $361.28	Professional	TC	$204.66	$282.60	$361.28