Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $101.73 / $106.63 / $1,300.00	Facility		$101.73	$106.63	$1,300.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.96 / $230.31 / $578.98	Professional		$152.96	$230.31	$578.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.29 / $43.81 / $126.15	Professional	26	$40.29	$43.81	$126.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.17 / $173.21 / $436.01	Professional	TC	$98.17	$173.21	$436.01
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $138.37 / $232.39 / $333.77	Professional		$138.37	$232.39	$333.77
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $42.95 / $46.80 / $72.81	Professional	26	$42.95	$46.80	$72.81
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $91.57 / $187.48 / $244.35	Professional	TC	$91.57	$187.48	$244.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.86 / $210.69 / $619.49	Professional		$133.86	$210.69	$619.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.90 / $57.25 / $121.84	Professional	26	$39.90	$57.25	$121.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.14 / $164.82 / $493.91	Professional	TC	$91.14	$164.82	$493.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $172.67 / $229.65 / $444.77	Professional		$172.67	$229.65	$444.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.82 / $52.96 / $84.35	Professional	26	$39.82	$52.96	$84.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $132.85 / $176.69 / $360.42	Professional	TC	$132.85	$176.69	$360.42
United Facility/Professional Professional Modifier Low / Median / High Price $142.05 / $193.40 / $350.73	Professional		$142.05	$193.40	$350.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.04 / $49.29 / $86.23	Professional	26	$37.04	$49.29	$86.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.92 / $143.22 / $289.11	Professional	TC	$98.92	$143.22	$289.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $111.01 / $198.57 / $245.19	Professional		$111.01	$198.57	$245.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.60 / $45.79 / $57.38	Professional	26	$25.60	$45.79	$57.38
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $85.41 / $152.78 / $187.82	Professional	TC	$85.41	$152.78	$187.82