Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $1,096.48 / $1,949.84	Facility		$251.19	$1,096.48	$1,949.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $41.69 / $44.67	Facility	26	$41.69	$41.69	$44.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $234.42 / $537.03	Professional		$165.96	$234.42	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $51.29 / $131.83	Professional	26	$33.88	$51.29	$131.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $165.96 / $380.19	Professional	TC	$131.83	$165.96	$380.19
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $181.97 / $218.78	Professional		$147.91	$181.97	$218.78
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $40.74 / $45.71	Professional	26	$33.11	$40.74	$45.71
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $165.96 / $208.93	Professional	TC	$125.89	$165.96	$208.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $194.98 / $275.42	Facility		$194.98	$194.98	$275.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $63.10 / $63.10	Facility	26	$63.10	$63.10	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $251.19 / $426.58	Professional		$173.78	$251.19	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $42.66 / $83.18	Professional	26	$31.62	$42.66	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $213.80 / $346.74	Professional	TC	$138.04	$213.80	$346.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $223.87 / $323.59	Professional		$194.98	$223.87	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $44.67 / $63.10	Professional	26	$34.67	$44.67	$63.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $181.97 / $257.04	Professional	TC	$154.88	$181.97	$257.04
United Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $117.49 / $194.98	Facility		$29.51	$117.49	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $239.88 / $398.11	Professional		$165.96	$239.88	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $40.74 / $77.62	Professional	26	$27.54	$40.74	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $199.53 / $323.59	Professional	TC	$131.83	$199.53	$323.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $239.88 / $281.84	Professional		$151.36	$239.88	$281.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $46.77 / $56.23	Professional	26	$31.62	$46.77	$56.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $194.98 / $229.09	Professional	TC	$120.23	$194.98	$229.09