Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $360.93 / $494.61 / $718.25	Facility	26	$360.93	$494.61	$718.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,629.41 / $2,115.42 / $5,721.04	Professional		$1,629.41	$2,115.42	$5,721.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $347.57 / $510.16 / $1,104.27	Professional	26	$347.57	$510.16	$1,104.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,268.47 / $1,608.83 / $3,399.49	Professional	TC	$1,268.47	$1,608.83	$3,399.49
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $2,179.55 / $2,179.55 / $3,878.33	Professional		$2,179.55	$2,179.55	$3,878.33
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $427.87 / $427.87 / $847.70	Professional	26	$427.87	$427.87	$847.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $1,751.68 / $1,751.68 / $2,332.75	Professional	TC	$1,751.68	$1,751.68	$2,332.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,482.31 / $2,254.65 / $5,055.47	Professional		$1,482.31	$2,254.65	$5,055.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $333.18 / $500.69 / $1,113.65	Professional	26	$333.18	$500.69	$1,113.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,155.78 / $1,781.27 / $3,933.25	Professional	TC	$1,155.78	$1,781.27	$3,933.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,928.29 / $2,487.48 / $4,215.14	Professional		$1,928.29	$2,487.48	$4,215.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $418.57 / $555.65 / $899.95	Professional	26	$418.57	$555.65	$899.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,497.55 / $1,931.84 / $3,305.32	Professional	TC	$1,497.55	$1,931.84	$3,305.32
United Facility/Professional Professional Modifier Low / Median / High Price $1,447.23 / $1,949.20 / $3,436.11	Professional		$1,447.23	$1,949.20	$3,436.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $296.27 / $432.71 / $739.61	Professional	26	$296.27	$432.71	$739.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,277.39 / $1,810.86 / $4,008.61	Professional	TC	$1,277.39	$1,810.86	$4,008.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,567.09 / $2,189.50 / $2,739.84	Professional		$1,567.09	$2,189.50	$2,739.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $350.09 / $495.35 / $591.38	Professional	26	$350.09	$495.35	$591.38
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $1,217.00 / $1,690.06 / $2,148.46	Professional	TC	$1,217.00	$1,690.06	$2,148.46