Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.52 / $76.18 / $112.47	Facility	26	$56.52	$76.18	$112.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $176.35 / $317.64 / $1,058.59	Professional		$176.35	$317.64	$1,058.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.63 / $89.83 / $247.37	Professional	26	$58.63	$89.83	$247.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.91 / $211.37 / $752.20	Professional	TC	$112.91	$211.37	$752.20
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $258.48 / $287.20 / $364.74	Professional		$258.48	$287.20	$364.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $65.93 / $71.95 / $94.53	Professional	26	$65.93	$71.95	$94.53
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $177.59 / $215.26 / $273.38	Professional	TC	$177.59	$215.26	$273.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $164.03 / $307.91 / $515.39	Professional		$164.03	$307.91	$515.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.67 / $76.48 / $151.71	Professional	26	$50.67	$76.48	$151.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.81 / $219.81 / $359.85	Professional	TC	$111.81	$219.81	$359.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $193.28 / $249.33 / $419.37	Professional		$193.28	$249.33	$419.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.61 / $78.61 / $115.82	Professional	26	$64.61	$78.61	$115.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $127.77 / $164.82 / $288.88	Professional	TC	$127.77	$164.82	$288.88
United Facility/Professional Professional Modifier Low / Median / High Price $167.43 / $266.81 / $444.38	Professional		$167.43	$266.81	$444.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.54 / $70.73 / $131.03	Professional	26	$34.54	$70.73	$131.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $111.53 / $161.96 / $318.67	Professional	TC	$111.53	$161.96	$318.67
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $154.62 / $209.83 / $272.77	Professional		$154.62	$209.83	$272.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $52.41 / $68.73 / $89.35	Professional	26	$52.41	$68.73	$89.35
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $102.22 / $141.10 / $180.38	Professional	TC	$102.22	$141.10	$180.38