Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $131.83 / $131.83	Facility	26	$131.83	$131.83	$131.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $457.09 / $1,445.44	Professional		$338.84	$457.09	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $181.97 / $467.74	Professional	26	$125.89	$181.97	$467.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $302.00 / $707.95	Professional	TC	$199.53	$302.00	$707.95
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $467.74 / $524.81	Professional		$165.96	$467.74	$524.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $147.91 / $169.82	Professional	26	$144.54	$147.91	$169.82
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $354.81 / $389.05	Professional	TC	$302.00	$354.81	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $478.63 / $1,258.93	Professional		$331.13	$478.63	$1,258.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $181.97 / $407.38	Professional	26	$120.23	$181.97	$407.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $338.84 / $851.14	Professional	TC	$218.78	$338.84	$851.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $549.54 / $794.33	Professional		$467.74	$549.54	$794.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $173.78 / $257.04	Professional	26	$154.88	$173.78	$257.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $371.54 / $501.19	Professional	TC	$323.59	$371.54	$501.19
United Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $407.38 / $758.58	Professional		$288.40	$407.38	$758.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $158.49 / $275.42	Professional	26	$109.65	$158.49	$275.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $478.63	Professional	TC	$169.82	$257.04	$478.63
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $562.34 / $741.31	Professional		$302.00	$562.34	$741.31
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $181.97 / $234.42	Professional	26	$97.72	$181.97	$234.42
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $380.19 / $512.86	Professional	TC	$199.53	$380.19	$512.86