Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $283.64 / $554.07 / $743.57	Facility		$283.64	$554.07	$743.57
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.29 / $32.59 / $34.44	Facility	26	$24.29	$32.59	$34.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $65.42 / $342.60 / $574.27	Facility	TC	$65.42	$342.60	$574.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.13 / $111.76 / $407.97	Professional		$81.13	$111.76	$407.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.29 / $36.09 / $110.96	Professional	26	$24.29	$36.09	$110.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.50 / $77.62 / $202.47	Professional	TC	$53.50	$77.62	$202.47
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $100.14 / $118.37 / $150.33	Professional		$100.14	$118.37	$150.33
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $27.70 / $30.78 / $39.09	Professional	26	$27.70	$30.78	$39.09
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $74.09 / $87.58 / $111.23	Professional	TC	$74.09	$87.58	$111.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $56.36 / $56.81 / $103.35	Facility		$56.36	$56.81	$103.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.50 / $107.39 / $196.73	Professional		$69.50	$107.39	$196.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.39 / $32.34 / $61.71	Professional	26	$21.39	$32.34	$61.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.80 / $73.95 / $141.91	Professional	TC	$47.80	$73.95	$141.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $89.85 / $115.17 / $159.46	Professional		$89.85	$115.17	$159.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.93 / $33.81 / $49.97	Professional	26	$27.93	$33.81	$49.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $61.79 / $78.48 / $112.88	Professional	TC	$61.79	$78.48	$112.88
United Facility/Professional Professional Modifier Low / Median / High Price $72.76 / $97.89 / $185.12	Professional		$72.76	$97.89	$185.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.53 / $29.95 / $54.09	Professional	26	$22.53	$29.95	$54.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.92 / $69.68 / $140.65	Professional	TC	$52.92	$69.68	$140.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $76.70 / $103.33 / $127.97	Professional		$76.70	$103.33	$127.97
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $23.96 / $32.27 / $40.74	Professional	26	$23.96	$32.27	$40.74
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $52.75 / $71.06 / $88.71	Professional	TC	$52.75	$71.06	$88.71