Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.75 / $207.51 / $609.26	Facility	26	$85.75	$207.51	$609.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $753.62 / $824.98 / $824.98	Professional		$753.62	$824.98	$824.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.88 / $85.75 / $85.75	Professional	26	$82.88	$85.75	$85.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $670.75 / $739.23 / $739.23	Professional	TC	$670.75	$739.23	$739.23
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $1,023.01 / $1,124.19 / $1,330.88	Professional		$1,023.01	$1,124.19	$1,330.88
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $113.40 / $114.81 / $125.14	Professional	26	$113.40	$114.81	$125.14
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $952.27 / $1,039.24 / $1,132.77	Professional	TC	$952.27	$1,039.24	$1,132.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,557.98 / $2,200.39 / $4,698.05	Professional		$1,557.98	$2,200.39	$4,698.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.76 / $155.00 / $468.05	Professional	26	$80.76	$155.00	$468.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,402.98 / $1,979.46 / $4,230.01	Professional	TC	$1,402.98	$1,979.46	$4,230.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $871.25 / $1,969.26 / $1,969.26	Professional		$871.25	$1,969.26	$1,969.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $95.90 / $209.55 / $209.55	Professional	26	$95.90	$209.55	$209.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $775.35 / $1,759.71 / $1,759.71	Professional	TC	$775.35	$1,759.71	$1,759.71
United Facility/Professional Professional Modifier Low / Median / High Price $804.27 / $2,332.25 / $2,945.81	Professional		$804.27	$2,332.25	$2,945.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.59 / $110.00 / $313.47	Professional	26	$79.59	$110.00	$313.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $724.67 / $1,947.94 / $2,632.34	Professional	TC	$724.67	$1,947.94	$2,632.34