Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $269.15 / $346.74 / $363.08	Facility	26	$269.15	$346.74	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,202.26 / $2,511.89	Professional		$1,000.00	$1,202.26	$2,511.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $426.58 / $870.96	Professional	26	$269.15	$426.58	$870.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $870.96 / $1,737.80	Professional	TC	$724.44	$870.96	$1,737.80
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $1,071.52 / $1,380.38	Professional		$316.23	$1,071.52	$1,380.38
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $281.84 / $281.84 / $489.78	Professional	26	$281.84	$281.84	$489.78
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $870.96 / $870.96 / $1,174.90	Professional	TC	$870.96	$870.96	$1,174.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,479.11 / $2,754.23	Professional		$977.24	$1,479.11	$2,754.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $275.42 / $416.87 / $812.83	Professional	26	$275.42	$416.87	$812.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $1,071.52 / $1,819.70	Professional	TC	$691.83	$1,071.52	$1,819.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,230.27 / $2,187.76	Professional		$1,071.52	$1,230.27	$2,187.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $295.12 / $338.84 / $602.56	Professional	26	$295.12	$338.84	$602.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $776.25 / $891.25 / $1,584.89	Professional	TC	$776.25	$891.25	$1,584.89
United Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,258.93 / $2,187.76	Professional		$891.25	$1,258.93	$2,187.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $257.04 / $354.81 / $616.60	Professional	26	$257.04	$354.81	$616.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $912.01 / $1,584.89	Professional	TC	$630.96	$912.01	$1,584.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,230.27 / $1,698.24	Professional		$891.25	$1,230.27	$1,698.24
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $257.04 / $346.74 / $457.09	Professional	26	$257.04	$346.74	$457.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $891.25 / $1,258.93	Professional	TC	$630.96	$891.25	$1,258.93