Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.12 / $90.12 / $90.12	Facility	26	$90.12	$90.12	$90.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $366.06 / $398.27 / $988.32	Professional		$366.06	$398.27	$988.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.12 / $94.63 / $236.29	Professional	26	$90.12	$94.63	$236.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $275.94 / $304.12 / $735.97	Professional	TC	$275.94	$304.12	$735.97
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $483.28 / $483.28 / $635.03	Professional		$483.28	$483.28	$635.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $108.26 / $108.26 / $142.25	Professional	26	$108.26	$108.26	$142.25
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $375.02 / $375.02 / $492.78	Professional	TC	$375.02	$375.02	$492.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.49 / $506.28 / $1,116.68	Professional		$323.49	$506.28	$1,116.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.00 / $125.43 / $278.99	Professional	26	$83.00	$125.43	$278.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $240.49 / $397.44 / $837.69	Professional	TC	$240.49	$397.44	$837.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $418.22 / $539.50 / $969.58	Professional		$418.22	$539.50	$969.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.31 / $138.43 / $226.88	Professional	26	$107.31	$138.43	$226.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $310.91 / $401.07 / $735.53	Professional	TC	$310.91	$401.07	$735.53
United Facility/Professional Professional Modifier Low / Median / High Price $325.87 / $440.43 / $811.82	Professional		$325.87	$440.43	$811.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.93 / $109.35 / $191.92	Professional	26	$75.93	$109.35	$191.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $250.33 / $351.51 / $624.60	Professional	TC	$250.33	$351.51	$624.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $373.68 / $475.92 / $594.04	Professional		$373.68	$475.92	$594.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $95.89 / $123.41 / $147.47	Professional	26	$95.89	$123.41	$147.47
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $277.79 / $351.34 / $446.58	Professional	TC	$277.79	$351.34	$446.58