Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $267.29 / $335.75 / $531.90	Facility	26	$267.29	$335.75	$531.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,012.82 / $1,133.92 / $2,971.43	Professional		$1,012.82	$1,133.92	$2,971.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $270.77 / $334.11 / $1,326.81	Professional	26	$270.77	$334.11	$1,326.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $728.19 / $814.86 / $1,924.47	Professional	TC	$728.19	$814.86	$1,924.47
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $1,194.46 / $1,242.08 / $1,577.44	Professional		$1,194.46	$1,242.08	$1,577.44
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $314.82 / $327.29 / $415.66	Professional	26	$314.82	$327.29	$415.66
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $879.64 / $914.78 / $1,161.77	Professional	TC	$879.64	$914.78	$1,161.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,001.47 / $1,573.03 / $2,811.80	Professional		$1,001.47	$1,573.03	$2,811.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $285.39 / $424.43 / $893.36	Professional	26	$285.39	$424.43	$893.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $716.08 / $1,121.25 / $1,999.10	Professional	TC	$716.08	$1,121.25	$1,999.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,035.70 / $1,336.05 / $2,427.98	Professional		$1,035.70	$1,336.05	$2,427.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $296.45 / $382.42 / $639.92	Professional	26	$296.45	$382.42	$639.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $739.26 / $953.65 / $1,788.04	Professional	TC	$739.26	$953.65	$1,788.04
United Facility/Professional Professional Modifier Low / Median / High Price $885.67 / $1,194.51 / $2,195.76	Professional		$885.67	$1,194.51	$2,195.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $265.68 / $373.26 / $646.02	Professional	26	$265.68	$373.26	$646.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $677.22 / $864.47 / $1,586.02	Professional	TC	$677.22	$864.47	$1,586.02
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $890.17 / $890.17 / $1,464.18	Professional		$890.17	$890.17	$1,464.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $254.77 / $254.77 / $419.70	Professional	26	$254.77	$254.77	$419.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $635.40 / $635.40 / $1,044.48	Professional	TC	$635.40	$635.40	$1,044.48