Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $79.43 / $79.43	Facility	26	$79.43	$79.43	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $169.82 / $478.63	Professional		$109.65	$169.82	$478.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $61.66 / $234.42	Professional	TC	$41.69	$61.66	$234.42
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $158.49 / $213.80	Professional		$112.20	$158.49	$213.80
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $61.66 / $79.43	Professional	TC	$56.23	$61.66	$79.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $186.21 / $389.05	Professional		$114.82	$186.21	$389.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $69.18 / $147.91	Professional	TC	$42.66	$69.18	$147.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $169.82 / $263.03	Professional		$144.54	$169.82	$263.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $107.15 / $158.49	Professional	26	$91.20	$107.15	$158.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $64.57 / $100.00	Professional	TC	$54.95	$64.57	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $165.96 / $275.42	Professional		$125.89	$165.96	$275.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $67.61 / $112.20	Professional	TC	$45.71	$67.61	$112.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $173.78 / $229.09	Professional		$134.90	$173.78	$229.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $66.07 / $89.13	Professional	TC	$51.29	$66.07	$89.13