Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $794.33 / $1,288.25	Facility		$102.33	$794.33	$1,288.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $251.19 / $645.65	Professional		$154.88	$251.19	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $63.10 / $165.96	Professional	26	$39.81	$63.10	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $173.78 / $371.54	Professional	TC	$107.15	$173.78	$371.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $177.83 / $263.03	Professional		$114.82	$177.83	$263.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $43.65 / $58.88	Professional	26	$38.90	$43.65	$58.88
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $138.04 / $199.53	Professional	TC	$138.04	$138.04	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $234.42 / $524.81	Professional		$138.04	$234.42	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $56.23 / $117.49	Professional	26	$39.81	$56.23	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $165.96 / $416.87	Professional	TC	$102.33	$165.96	$416.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $190.55 / $316.23	Professional		$165.96	$190.55	$316.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $47.86 / $79.43	Professional	26	$40.74	$47.86	$79.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $144.54 / $239.88	Professional	TC	$123.03	$144.54	$239.88
United Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Facility		$128.82	$128.82	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $190.55 / $389.05	Professional		$134.90	$190.55	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $52.48 / $97.72	Professional	26	$35.48	$52.48	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $144.54 / $288.40	Professional	TC	$97.72	$144.54	$288.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $213.80 / $257.04	Professional		$112.20	$213.80	$257.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $53.70 / $60.26	Professional	26	$25.70	$53.70	$60.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $162.18 / $199.53	Professional	TC	$85.11	$162.18	$199.53