Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $97.72 / $100.00	Facility	26	$70.79	$97.72	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $812.83 / $2,754.23	Professional		$407.38	$812.83	$2,754.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $141.25 / $288.40	Professional	26	$70.79	$141.25	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $549.54 / $1,479.11	Professional	TC	$346.74	$549.54	$1,479.11
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $501.19 / $676.08	Professional		$204.17	$501.19	$676.08
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $89.13 / $112.20	Professional	26	$79.43	$89.13	$112.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $416.87 / $562.34	Professional	TC	$371.54	$416.87	$562.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $562.34 / $1,230.27	Professional		$354.81	$562.34	$1,230.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $97.72 / $218.78	Professional	26	$64.57	$97.72	$218.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $489.78 / $1,000.00	Professional	TC	$288.40	$489.78	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $575.44 / $12,882.50	Professional		$446.68	$575.44	$12,882.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $100.00 / $12,882.50	Professional	26	$81.28	$100.00	$12,882.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $489.78 / $12,882.50	Professional	TC	$371.54	$489.78	$12,882.50
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $501.19 / $912.01	Professional		$338.84	$501.19	$912.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $85.11 / $147.91	Professional	26	$58.88	$85.11	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $426.58 / $776.25	Professional	TC	$275.42	$426.58	$776.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $537.03 / $741.31	Professional		$416.87	$537.03	$741.31
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $97.72 / $125.89	Professional	26	$75.86	$97.72	$125.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $446.68 / $616.60	Professional	TC	$338.84	$446.68	$616.60