Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.82 / $87.82 / $87.82	Facility	26	$87.82	$87.82	$87.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $814.16 / $940.81 / $1,376.38	Professional		$814.16	$940.81	$1,376.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $730.06 / $850.45 / $1,233.61	Professional	TC	$730.06	$850.45	$1,233.61
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $815.82 / $930.16 / $1,181.30	Professional		$815.82	$930.16	$1,181.30
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $693.14 / $814.31 / $1,034.17	Professional	TC	$693.14	$814.31	$1,034.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $671.82 / $1,182.28 / $2,573.54	Professional		$671.82	$1,182.28	$2,573.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $601.71 / $1,061.15 / $2,324.11	Professional	TC	$601.71	$1,061.15	$2,324.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $933.64 / $1,186.86 / $1,825.29	Professional		$933.64	$1,186.86	$1,825.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.28 / $132.77 / $204.00	Professional	26	$101.28	$132.77	$204.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $835.87 / $1,069.59 / $1,658.53	Professional	TC	$835.87	$1,069.59	$1,658.53
United Facility/Professional Professional Modifier Low / Median / High Price $472.29 / $842.45 / $1,573.67	Professional		$472.29	$842.45	$1,573.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $415.19 / $742.49 / $1,350.36	Professional	TC	$415.19	$742.49	$1,350.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $627.42 / $1,111.19 / $1,402.66	Professional		$627.42	$1,111.19	$1,402.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $561.74 / $994.50 / $1,264.07	Professional	TC	$561.74	$994.50	$1,264.07