Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $64.57 / $89.13	Facility	26	$64.57	$64.57	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $371.54 / $1,412.54	Professional		$204.17	$371.54	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $117.49 / $275.42	Professional	26	$64.57	$117.49	$275.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $194.98 / $436.52	Professional	TC	$131.83	$194.98	$436.52
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $275.42 / $338.84	Professional		$93.33	$275.42	$338.84
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $104.71 / $131.83	Professional	26	$87.10	$104.71	$131.83
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $218.78 / $251.19	Professional	TC	$194.98	$218.78	$251.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $123.03 / $123.03	Facility	26	$123.03	$123.03	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $302.00 / $562.34	Professional		$190.55	$302.00	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $87.10 / $169.82	Professional	26	$58.88	$87.10	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $199.53 / $380.19	Professional	TC	$123.03	$199.53	$380.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $251.19 / $354.81	Professional		$223.87	$251.19	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $83.18 / $114.82	Professional	26	$74.13	$83.18	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $169.82 / $239.88	Professional	TC	$151.36	$169.82	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $363.08 / $1,000.00	Professional		$218.78	$363.08	$1,000.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $81.28 / $138.04	Professional	26	$42.66	$81.28	$138.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $275.42 / $891.25	Professional	TC	$151.36	$275.42	$891.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $263.03 / $363.08	Professional		$223.87	$263.03	$363.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $87.10 / $114.82	Professional	26	$74.13	$87.10	$114.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $177.83 / $245.47	Professional	TC	$147.91	$177.83	$245.47