Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $127.16 / $576.77 / $887.70	Facility		$127.16	$576.77	$887.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.00 / $36.29 / $59.70	Facility	26	$30.00	$36.29	$59.70
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $79.91 / $283.64 / $638.91	Facility	TC	$79.91	$283.64	$638.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.59 / $146.49 / $559.20	Professional		$96.59	$146.49	$559.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.08 / $46.33 / $146.34	Professional	26	$31.08	$46.33	$146.34
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $46.46 / $52.24 / $181.01	Professional	52	$46.46	$52.24	$181.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.59 / $95.89 / $264.48	Professional	TC	$66.59	$95.89	$264.48
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $128.99 / $143.32 / $182.02	Professional		$128.99	$143.32	$182.02
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $34.71 / $38.56 / $56.30	Professional	26	$34.71	$38.56	$56.30
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $94.28 / $104.76 / $133.05	Professional	TC	$94.28	$104.76	$133.05
Cigna Facility/Professional Facility Modifier Low / Median / High Price $56.36 / $56.81 / $138.60	Facility		$56.36	$56.81	$138.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $86.68 / $133.47 / $245.00	Professional		$86.68	$133.47	$245.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.15 / $40.31 / $77.14	Professional	26	$27.15	$40.31	$77.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $59.54 / $93.35 / $175.89	Professional	TC	$59.54	$93.35	$175.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $111.69 / $142.47 / $196.94	Professional		$111.69	$142.47	$196.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.00 / $42.37 / $62.33	Professional	26	$35.00	$42.37	$62.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $76.51 / $97.17 / $139.41	Professional	TC	$76.51	$97.17	$139.41
United Facility/Professional Professional Modifier Low / Median / High Price $91.85 / $120.93 / $207.59	Professional		$91.85	$120.93	$207.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.18 / $36.88 / $69.64	Professional	26	$27.18	$36.88	$69.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.40 / $93.10 / $179.94	Professional	TC	$66.40	$93.10	$179.94
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $98.79 / $128.44 / $158.94	Professional		$98.79	$128.44	$158.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.11 / $40.45 / $51.05	Professional	26	$31.11	$40.45	$51.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $67.67 / $87.99 / $109.75	Professional	TC	$67.67	$87.99	$109.75