Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.38 / $93.54 / $568.37	Facility		$62.38	$93.54	$568.37
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.22 / $13.22 / $18.11	Facility	26	$13.22	$13.22	$18.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.13 / $102.27 / $254.01	Professional		$85.13	$102.27	$254.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.22 / $15.04 / $53.63	Professional	26	$13.22	$15.04	$53.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.62 / $88.54 / $208.91	Professional	TC	$71.62	$88.54	$208.91
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $86.39 / $110.49 / $126.29	Professional		$86.39	$110.49	$126.29
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $15.35 / $17.05 / $19.48	Professional	26	$15.35	$17.05	$19.48
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $68.62 / $93.43 / $106.79	Professional	TC	$68.62	$93.43	$106.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $95.46 / $95.46 / $95.46	Facility		$95.46	$95.46	$95.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.66 / $103.72 / $232.98	Professional		$76.66	$103.72	$232.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.96 / $18.51 / $35.88	Professional	26	$11.96	$18.51	$35.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.68 / $88.08 / $197.80	Professional	TC	$63.68	$88.08	$197.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $98.40 / $125.02 / $187.63	Professional		$98.40	$125.02	$187.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.48 / $18.60 / $28.22	Professional	26	$15.48	$18.60	$28.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $84.55 / $104.44 / $157.75	Professional	TC	$84.55	$104.44	$157.75
United Facility/Professional Facility Modifier Low / Median / High Price $14.61 / $55.93 / $138.91	Facility		$14.61	$55.93	$138.91
United Facility/Professional Professional Modifier Low / Median / High Price $70.16 / $98.89 / $174.52	Professional		$70.16	$98.89	$174.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.56 / $17.43 / $37.21	Professional	26	$12.56	$17.43	$37.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.62 / $82.29 / $173.50	Professional	TC	$58.62	$82.29	$173.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.33 / $115.76 / $149.76	Professional		$69.33	$115.76	$149.76
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.18 / $16.57 / $22.59	Professional	26	$10.18	$16.57	$22.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $59.15 / $99.47 / $127.17	Professional	TC	$59.15	$99.47	$127.17