Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $274.99 / $1,210.00 / $1,905.50	Facility		$274.99	$1,210.00	$1,905.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.52 / $43.15 / $67.20	Facility	26	$40.52	$43.15	$67.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $232.19 / $235.76 / $1,669.54	Facility	TC	$232.19	$235.76	$1,669.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.00 / $254.43 / $884.00	Professional		$180.00	$254.43	$884.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.96 / $37.11 / $93.47	Professional	26	$26.96	$37.11	$93.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.34 / $210.82 / $518.58	Professional	TC	$162.34	$210.82	$518.58
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $197.30 / $217.05 / $316.89	Professional		$197.30	$217.05	$316.89
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $29.08 / $32.26 / $47.10	Professional	26	$29.08	$32.26	$47.10
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $166.90 / $184.79 / $269.79	Professional	TC	$166.90	$184.79	$269.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $248.45 / $248.45 / $248.45	Facility		$248.45	$248.45	$248.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $226.04 / $333.92 / $546.04	Professional		$226.04	$333.92	$546.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.86 / $44.37 / $81.53	Professional	26	$28.86	$44.37	$81.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $197.80 / $302.27 / $469.20	Professional	TC	$197.80	$302.27	$469.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $246.12 / $309.82 / $463.84	Professional		$246.12	$309.82	$463.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $47.37 / $62.25	Professional	26	$36.54	$47.37	$62.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $208.82 / $265.12 / $401.60	Professional	TC	$208.82	$265.12	$401.60
United Facility/Professional Professional Modifier Low / Median / High Price $225.62 / $311.22 / $535.86	Professional		$225.62	$311.22	$535.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.14 / $38.79 / $74.98	Professional	26	$24.14	$38.79	$74.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $191.76 / $280.82 / $523.71	Professional	TC	$191.76	$280.82	$523.71
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $207.69 / $283.04 / $350.23	Professional		$207.69	$283.04	$350.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.49 / $42.89 / $53.94	Professional	26	$31.49	$42.89	$53.94
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $176.20 / $240.14 / $299.70	Professional	TC	$176.20	$240.14	$299.70