Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.58 / $49.58 / $49.58	Facility	26	$49.58	$49.58	$49.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.73 / $285.58 / $1,091.03	Professional		$208.73	$285.58	$1,091.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.58 / $57.48 / $154.79	Professional	26	$49.58	$57.48	$154.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.15 / $214.85 / $915.42	Professional	TC	$159.15	$214.85	$915.42
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $327.39 / $343.00 / $392.05	Professional		$327.39	$343.00	$392.05
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.28 / $63.79 / $74.30	Professional	26	$58.28	$63.79	$74.30
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $260.52 / $279.20 / $319.14	Professional	TC	$260.52	$279.20	$319.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $227.37 / $406.47 / $709.66	Professional		$227.37	$406.47	$709.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.64 / $68.06 / $130.37	Professional	26	$44.64	$68.06	$130.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $180.92 / $330.92 / $558.46	Professional	TC	$180.92	$330.92	$558.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.94 / $340.48 / $555.16	Professional		$263.94	$340.48	$555.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.94 / $69.25 / $102.30	Professional	26	$56.94	$69.25	$102.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $206.23 / $266.04 / $436.03	Professional	TC	$206.23	$266.04	$436.03
United Facility/Professional Professional Modifier Low / Median / High Price $172.59 / $301.75 / $528.33	Professional		$172.59	$301.75	$528.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.47 / $65.78 / $119.77	Professional	26	$30.47	$65.78	$119.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $170.17 / $246.77 / $455.09	Professional	TC	$170.17	$246.77	$455.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $199.71 / $272.61 / $354.39	Professional		$199.71	$272.61	$354.39
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.17 / $60.57 / $78.73	Professional	26	$46.17	$60.57	$78.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $153.54 / $212.05 / $271.08	Professional	TC	$153.54	$212.05	$271.08