Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $153.53 / $520.66 / $826.80	Facility		$153.53	$520.66	$826.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.86 / $44.75 / $65.39	Facility	26	$32.86	$44.75	$65.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.63 / $153.53 / $558.00	Professional		$103.63	$153.53	$558.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.28 / $50.67 / $171.24	Professional	26	$33.28	$50.67	$171.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.77 / $99.56 / $292.92	Professional	TC	$70.77	$99.56	$292.92
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $132.09 / $146.77 / $187.87	Professional		$132.09	$146.77	$187.87
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.06 / $42.29 / $61.74	Professional	26	$38.06	$42.29	$61.74
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $94.04 / $104.48 / $132.88	Professional	TC	$94.04	$104.48	$132.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $56.36 / $56.81 / $142.35	Facility		$56.36	$56.81	$142.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.49 / $144.59 / $272.89	Professional		$92.49	$144.59	$272.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.47 / $45.18 / $84.46	Professional	26	$29.47	$45.18	$84.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.18 / $98.96 / $190.99	Professional	TC	$63.18	$98.96	$190.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $119.58 / $151.87 / $212.96	Professional		$119.58	$151.87	$212.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.36 / $46.45 / $68.79	Professional	26	$38.36	$46.45	$68.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.05 / $102.93 / $149.88	Professional	TC	$81.05	$102.93	$149.88
United Facility/Professional Professional Modifier Low / Median / High Price $100.81 / $128.80 / $215.94	Professional		$100.81	$128.80	$215.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $40.13 / $73.40	Professional	26	$30.90	$40.13	$73.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.36 / $93.30 / $171.72	Professional	TC	$68.36	$93.30	$171.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $102.56 / $137.52 / $170.28	Professional		$102.56	$137.52	$170.28
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.04 / $44.31 / $55.95	Professional	26	$33.04	$44.31	$55.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $69.52 / $93.21 / $116.27	Professional	TC	$69.52	$93.21	$116.27