Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.94 / $131.12 / $190.92	Facility	26	$95.94	$131.12	$190.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $254.80 / $414.14 / $1,262.33	Professional		$254.80	$414.14	$1,262.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.94 / $120.57 / $525.66	Professional	26	$95.94	$120.57	$525.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.85 / $220.00 / $565.09	Professional	TC	$158.85	$220.00	$565.09
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $488.03 / $488.03 / $770.39	Professional		$488.03	$488.03	$770.39
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $116.11 / $124.56 / $145.01	Professional	26	$116.11	$124.56	$145.01
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $363.47 / $363.47 / $654.28	Professional	TC	$363.47	$363.47	$654.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $337.74 / $659.66 / $1,151.88	Professional		$337.74	$659.66	$1,151.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.45 / $132.83 / $259.85	Professional	26	$86.45	$132.83	$259.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $254.11 / $501.02 / $856.44	Professional	TC	$254.11	$501.02	$856.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $432.99 / $519.59 / $779.82	Professional		$432.99	$519.59	$779.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $111.11 / $135.52 / $185.19	Professional	26	$111.11	$135.52	$185.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $320.05 / $388.89 / $594.64	Professional	TC	$320.05	$388.89	$594.64
United Facility/Professional Professional Modifier Low / Median / High Price $321.56 / $495.84 / $1,023.84	Professional		$321.56	$495.84	$1,023.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.45 / $120.90 / $208.68	Professional	26	$70.45	$120.90	$208.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $260.14 / $390.12 / $635.91	Professional	TC	$260.14	$390.12	$635.91
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $243.89 / $330.25 / $429.33	Professional		$243.89	$330.25	$429.33
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $90.34 / $118.20 / $153.66	Professional	26	$90.34	$118.20	$153.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $153.54 / $212.05 / $271.08	Professional	TC	$153.54	$212.05	$271.08