Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.77 / $57.54 / $64.57	Facility	26	$46.77	$57.54	$64.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $331.13 / $1,122.02	Professional		$223.87	$331.13	$1,122.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $107.15 / $208.93	Professional	26	$52.48	$107.15	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $229.09 / $446.68	Professional	TC	$162.18	$229.09	$446.68
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $295.12 / $380.19	Professional		$64.57	$295.12	$380.19
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $70.79 / $97.72	Professional	26	$60.26	$70.79	$97.72
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $257.04 / $338.84	Professional	TC	$229.09	$257.04	$338.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Facility	26	$89.13	$89.13	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $309.03 / $562.34	Professional		$199.53	$309.03	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $64.57 / $117.49	Professional	26	$42.66	$64.57	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $245.47 / $489.78	Professional	TC	$151.36	$245.47	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $275.42 / $371.54	Professional		$234.42	$275.42	$371.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $61.66 / $83.18	Professional	26	$53.70	$61.66	$83.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $213.80 / $288.40	Professional	TC	$181.97	$213.80	$288.40
United Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $288.40 / $446.68	Professional		$181.97	$288.40	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $58.88 / $102.33	Professional	26	$33.11	$58.88	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $223.87 / $363.08	Professional	TC	$147.91	$223.87	$363.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $275.42 / $380.19	Professional		$223.87	$275.42	$380.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $64.57 / $83.18	Professional	26	$51.29	$64.57	$83.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $213.80 / $295.12	Professional	TC	$173.78	$213.80	$295.12