Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $283.64 / $337.25 / $1,394.00	Facility		$283.64	$337.25	$1,394.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.92 / $53.64 / $192.22	Facility	26	$20.92	$53.64	$192.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.47 / $130.13 / $337.44	Professional		$119.47	$130.13	$337.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.44 / $20.92 / $43.22	Professional	26	$18.44	$20.92	$43.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.26 / $109.21 / $189.87	Professional	TC	$102.26	$109.21	$189.87
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $130.49 / $151.04 / $502.83	Professional		$130.49	$151.04	$502.83
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $19.48 / $20.74 / $24.69	Professional	26	$19.48	$20.74	$24.69
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $111.82 / $131.56 / $144.41	Professional	TC	$111.82	$131.56	$144.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $557.01 / $896.90 / $1,230.83	Facility		$557.01	$896.90	$1,230.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $143.74 / $197.35 / $447.92	Professional		$143.74	$197.35	$447.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.99 / $29.87 / $64.31	Professional	26	$20.99	$29.87	$64.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.75 / $175.59 / $383.61	Professional	TC	$122.75	$175.59	$383.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.78 / $177.79 / $343.73	Professional		$147.78	$177.79	$343.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.72 / $25.98 / $50.19	Professional	26	$22.72	$25.98	$50.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.06 / $151.81 / $293.54	Professional	TC	$125.06	$151.81	$293.54
United Facility/Professional Professional Modifier Low / Median / High Price $137.72 / $246.40 / $435.28	Professional		$137.72	$246.40	$435.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.94 / $44.12 / $63.55	Professional	26	$17.94	$44.12	$63.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.35 / $169.66 / $371.73	Professional	TC	$112.35	$169.66	$371.73