Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $363.08 / $489.78 / $512.86	Facility	26	$363.08	$489.78	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $3,090.30 / $8,709.64	Professional		$1,659.59	$3,090.30	$8,709.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $371.54 / $724.44 / $1,949.84	Professional	26	$371.54	$724.44	$1,949.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,230.27 / $1,995.26 / $4,897.79	Professional	TC	$1,230.27	$1,995.26	$4,897.79
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $2,089.30 / $4,897.79	Professional		$1,479.11	$2,089.30	$4,897.79
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $407.38 / $457.09 / $758.58	Professional	26	$407.38	$457.09	$758.58
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $1,479.11 / $1,659.59 / $2,238.72	Professional	TC	$1,479.11	$1,659.59	$2,238.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $2,238.72 / $5,011.87	Professional		$1,479.11	$2,238.72	$5,011.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $501.19 / $1,122.02	Professional	26	$331.13	$501.19	$1,122.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,148.15 / $1,819.70 / $3,981.07	Professional	TC	$1,148.15	$1,819.70	$3,981.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $2,398.83 / $4,073.80	Professional		$1,995.26	$2,398.83	$4,073.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $416.87 / $478.63 / $891.25	Professional	26	$416.87	$478.63	$891.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,584.89 / $1,905.46 / $3,311.31	Professional	TC	$1,584.89	$1,905.46	$3,311.31
United Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $1,995.26 / $3,548.13	Professional		$1,445.44	$1,995.26	$3,548.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $295.12 / $436.52 / $758.58	Professional	26	$295.12	$436.52	$758.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,096.48 / $1,584.89 / $2,754.23	Professional	TC	$1,096.48	$1,584.89	$2,754.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $2,398.83 / $3,019.95	Professional		$1,584.89	$2,398.83	$3,019.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $346.74 / $501.19 / $645.65	Professional	26	$346.74	$501.19	$645.65
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $1,230.27 / $1,905.46 / $2,398.83	Professional	TC	$1,230.27	$1,905.46	$2,398.83