Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.02 / $34.02 / $34.02	Facility	26	$34.02	$34.02	$34.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.93 / $104.75 / $410.91	Professional		$90.93	$104.75	$410.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.58 / $69.45 / $319.13	Professional	TC	$57.58	$69.45	$319.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $136.06 / $137.61 / $219.79	Professional		$136.06	$137.61	$219.79
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $89.55 / $94.20 / $176.14	Professional	TC	$89.55	$94.20	$176.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $86.47 / $139.66 / $282.89	Professional		$86.47	$139.66	$282.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.78 / $94.77 / $200.78	Professional	TC	$54.78	$94.77	$200.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $111.79 / $144.21 / $200.37	Professional		$111.79	$144.21	$200.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.70 / $47.51 / $69.36	Professional	26	$39.70	$47.51	$69.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $71.56 / $92.31 / $124.00	Professional	TC	$71.56	$92.31	$124.00
United Facility/Professional Professional Modifier Low / Median / High Price $90.39 / $133.21 / $197.56	Professional		$90.39	$133.21	$197.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.69 / $82.61 / $158.05	Professional	TC	$53.69	$82.61	$158.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $89.43 / $121.26 / $157.63	Professional		$89.43	$121.26	$157.63
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $57.25 / $79.03 / $101.04	Professional	TC	$57.25	$79.03	$101.04