Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $97.72	Facility	26	$89.13	$89.13	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $346.74 / $1,096.48	Professional		$218.78	$346.74	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $125.89 / $380.19	Professional	26	$77.62	$125.89	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $181.97 / $426.58	Professional	TC	$138.04	$181.97	$426.58
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $257.04 / $309.03	Professional		$97.72	$257.04	$309.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $85.11 / $102.33	Professional	26	$77.62	$85.11	$102.33
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $173.78 / $194.98	Professional	TC	$154.88	$173.78	$194.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $131.83 / $131.83	Facility	26	$131.83	$131.83	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $331.13 / $549.54	Professional		$234.42	$331.13	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $112.20 / $194.98	Professional	26	$79.43	$112.20	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $204.17 / $371.54	Professional	TC	$151.36	$204.17	$371.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $288.40 / $436.52	Professional		$245.47	$288.40	$436.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $97.72 / $131.83	Professional	26	$83.18	$97.72	$131.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $190.55 / $295.12	Professional	TC	$162.18	$190.55	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $275.42 / $478.63	Professional		$208.93	$275.42	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $100.00 / $165.96	Professional	26	$74.13	$100.00	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $181.97 / $309.03	Professional	TC	$131.83	$181.97	$309.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $309.03 / $363.08	Professional		$213.80	$309.03	$363.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $102.33 / $123.03	Professional	26	$74.13	$102.33	$123.03
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $204.17 / $239.88	Professional	TC	$141.25	$204.17	$239.88