Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $193.59 / $265.29 / $385.24	Facility	26	$193.59	$265.29	$385.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $407.72 / $483.96 / $1,092.68	Professional		$407.72	$483.96	$1,092.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $188.34 / $270.75 / $628.66	Professional	26	$188.34	$270.75	$628.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.12 / $239.11 / $573.84	Professional	TC	$214.12	$239.11	$573.84
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $566.44 / $566.44 / $827.00	Professional		$566.44	$566.44	$827.00
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $230.12 / $230.12 / $302.38	Professional	26	$230.12	$230.12	$302.38
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $336.32 / $336.32 / $441.93	Professional	TC	$336.32	$336.32	$441.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $376.17 / $566.39 / $1,274.66	Professional		$376.17	$566.39	$1,274.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $178.43 / $268.97 / $598.25	Professional	26	$178.43	$268.97	$598.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $200.90 / $316.27 / $682.56	Professional	TC	$200.90	$316.27	$682.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $491.41 / $610.97 / $1,031.33	Professional		$491.41	$610.97	$1,031.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $227.10 / $280.27 / $442.72	Professional	26	$227.10	$280.27	$442.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $260.72 / $330.71 / $575.14	Professional	TC	$260.72	$330.71	$575.14
United Facility/Professional Professional Modifier Low / Median / High Price $350.93 / $535.61 / $976.47	Professional		$350.93	$535.61	$976.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $164.40 / $251.30 / $397.26	Professional	26	$164.40	$251.30	$397.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $198.89 / $290.66 / $508.11	Professional	TC	$198.89	$290.66	$508.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $428.28 / $561.67 / $690.66	Professional		$428.28	$561.67	$690.66
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $201.03 / $265.27 / $316.82	Professional	26	$201.03	$265.27	$316.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $227.25 / $294.06 / $373.84	Professional	TC	$227.25	$294.06	$373.84