Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $752.13 / $1,139.86 / $1,864.09	Facility		$752.13	$1,139.86	$1,864.09
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.17 / $37.65 / $42.12	Facility	26	$36.17	$37.65	$42.12
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $177.83 / $633.99 / $1,309.61	Facility	TC	$177.83	$633.99	$1,309.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.35 / $214.39 / $869.00	Professional		$178.35	$214.39	$869.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.63 / $36.43 / $144.94	Professional	26	$30.63	$36.43	$144.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $148.19 / $169.96 / $427.06	Professional	TC	$148.19	$169.96	$427.06
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $177.40 / $197.11 / $287.77	Professional		$177.40	$197.11	$287.77
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $29.44 / $32.72 / $47.77	Professional	26	$29.44	$32.72	$47.77
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $147.94 / $164.39 / $233.77	Professional	TC	$147.94	$164.39	$233.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $215.24 / $215.24 / $215.24	Facility		$215.24	$215.24	$215.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $178.93 / $269.27 / $423.45	Professional		$178.93	$269.27	$423.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.00 / $44.24 / $72.09	Professional	26	$30.00	$44.24	$72.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.87 / $233.19 / $355.40	Professional	TC	$148.87	$233.19	$355.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $192.11 / $247.82 / $356.60	Professional		$192.11	$247.82	$356.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.54 / $41.33 / $60.57	Professional	26	$32.54	$41.33	$60.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $159.58 / $205.86 / $301.64	Professional	TC	$159.58	$205.86	$301.64
United Facility/Professional Professional Modifier Low / Median / High Price $167.03 / $250.47 / $472.52	Professional		$167.03	$250.47	$472.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.27 / $38.22 / $80.84	Professional	26	$27.27	$38.22	$80.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.34 / $209.64 / $355.08	Professional	TC	$143.34	$209.64	$355.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $158.01 / $220.93 / $273.13	Professional		$158.01	$220.93	$273.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.77 / $37.42 / $47.09	Professional	26	$26.77	$37.42	$47.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $131.26 / $183.52 / $229.03	Professional	TC	$131.26	$183.52	$229.03