Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $490.42 / $698.88 / $915.52	Facility		$490.42	$698.88	$915.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $438.46 / $566.25 / $772.72	Facility	26	$438.46	$566.25	$772.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.85 / $86.02 / $233.32	Professional		$56.85	$86.02	$233.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.40 / $47.18 / $91.96	Professional	26	$34.40	$47.18	$91.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.98 / $39.15 / $150.03	Professional	TC	$26.98	$39.15	$150.03
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $76.81 / $80.56 / $243.03	Professional		$76.81	$80.56	$243.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $44.16 / $115.36	Professional	26	$41.81	$44.16	$115.36
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $31.49 / $36.40 / $152.63	Professional	TC	$31.49	$36.40	$152.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $113.85 / $309.88	Professional		$65.00	$113.85	$309.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.54 / $62.63 / $119.49	Professional	26	$35.54	$62.63	$119.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.71 / $49.72 / $177.94	Professional	TC	$28.71	$49.72	$177.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $49.55 / $74.23 / $112.43	Professional		$49.55	$74.23	$112.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.79 / $40.65 / $59.97	Professional	26	$27.79	$40.65	$59.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.77 / $33.36 / $52.45	Professional	TC	$21.77	$33.36	$52.45
United Facility/Professional Professional Modifier Low / Median / High Price $61.99 / $122.86 / $289.93	Professional		$61.99	$122.86	$289.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.77 / $63.63 / $97.54	Professional	26	$33.77	$63.63	$97.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.98 / $55.00 / $160.22	Professional	TC	$25.98	$55.00	$160.22
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.06 / $75.48 / $94.35	Professional		$66.06	$75.48	$94.35
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.04 / $42.61 / $53.46	Professional	26	$37.04	$42.61	$53.46
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $29.02 / $32.71 / $40.89	Professional	TC	$29.02	$32.71	$40.89