Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.38 / $85.01 / $476.53	Facility		$58.38	$85.01	$476.53
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.17 / $27.81 / $31.01	Facility	26	$23.17	$27.81	$31.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.89 / $112.90 / $454.00	Professional		$74.89	$112.90	$454.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.18 / $28.09 / $123.50	Professional	26	$23.18	$28.09	$123.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.89 / $88.86 / $216.06	Professional	TC	$49.89	$88.86	$216.06
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $85.37 / $123.73 / $141.43	Professional		$85.37	$123.73	$141.43
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $28.99 / $31.67 / $36.20	Professional	26	$28.99	$31.67	$36.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $55.56 / $92.06 / $105.23	Professional	TC	$55.56	$92.06	$105.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.42 / $112.81 / $317.54	Professional		$81.42	$112.81	$317.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.48 / $32.36 / $70.44	Professional	26	$20.48	$32.36	$70.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.47 / $82.17 / $247.11	Professional	TC	$55.47	$82.17	$247.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $118.19 / $154.91 / $274.26	Professional		$118.19	$154.91	$274.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.76 / $34.52 / $58.75	Professional	26	$26.76	$34.52	$58.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $91.43 / $121.21 / $214.80	Professional	TC	$91.43	$121.21	$214.80
United Facility/Professional Professional Modifier Low / Median / High Price $64.91 / $104.90 / $193.79	Professional		$64.91	$104.90	$193.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.34 / $28.47 / $48.82	Professional	26	$20.34	$28.47	$48.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.71 / $71.51 / $144.97	Professional	TC	$38.71	$71.51	$144.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $74.12 / $135.91 / $167.91	Professional		$74.12	$135.91	$167.91
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $16.78 / $30.77 / $38.78	Professional	26	$16.78	$30.77	$38.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $57.34 / $105.14 / $129.13	Professional	TC	$57.34	$105.14	$129.13