Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $97.72 / $134.90	Facility	26	$97.72	$97.72	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $380.19 / $1,659.59	Professional		$263.03	$380.19	$1,659.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $186.21 / $524.81	Professional	26	$93.33	$186.21	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $239.88 / $426.58	Professional	TC	$158.49	$239.88	$426.58
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $436.52 / $512.86	Professional		$295.12	$436.52	$512.86
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $144.54 / $158.49	Professional	26	$123.03	$144.54	$158.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $309.03 / $354.81	Professional	TC	$275.42	$309.03	$354.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $186.21 / $186.21 / $186.21	Facility	26	$186.21	$186.21	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $501.19 / $891.25	Professional		$275.42	$501.19	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $125.89 / $234.42	Professional	26	$85.11	$125.89	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $346.74 / $645.65	Professional	TC	$190.55	$346.74	$645.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $389.05 / $512.86	Professional		$338.84	$389.05	$512.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $125.89 / $173.78	Professional	26	$112.20	$125.89	$173.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $263.03 / $354.81	Professional	TC	$229.09	$263.03	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $457.09 / $812.83	Professional		$302.00	$457.09	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $120.23 / $208.93	Professional	26	$69.18	$120.23	$208.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $323.59 / $588.84	Professional	TC	$213.80	$323.59	$588.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $398.11 / $501.19	Professional		$302.00	$398.11	$501.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $131.83 / $169.82	Professional	26	$102.33	$131.83	$169.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $263.03 / $338.84	Professional	TC	$199.53	$263.03	$338.84