Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $239.12 / $458.00 / $964.32	Facility		$239.12	$458.00	$964.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $129.30 / $260.23 / $629.75	Professional		$129.30	$260.23	$629.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.85 / $154.56 / $686.05	Professional	26	$62.85	$154.56	$686.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.47 / $170.59 / $370.54	Professional	TC	$79.47	$170.59	$370.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $158.81 / $285.06 / $352.09	Professional		$158.81	$285.06	$352.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $91.56 / $91.87 / $196.17	Professional	26	$91.56	$91.87	$196.17
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $54.54 / $193.19 / $238.62	Professional	TC	$54.54	$193.19	$238.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.85 / $157.51 / $483.91	Professional		$82.85	$157.51	$483.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $0.91 / $44.19 / $129.47	Professional	26	$0.91	$44.19	$129.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $2.40 / $111.94 / $354.44	Professional	TC	$2.40	$111.94	$354.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $297.42 / $356.90 / $470.66	Professional		$297.42	$356.90	$470.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $79.88 / $97.07 / $140.03	Professional	26	$79.88	$97.07	$140.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $217.54 / $261.05 / $348.26	Professional	TC	$217.54	$261.05	$348.26
United Facility/Professional Professional Modifier Low / Median / High Price $145.44 / $217.18 / $422.25	Professional		$145.44	$217.18	$422.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.60 / $69.30 / $159.90	Professional	26	$51.60	$69.30	$159.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.85 / $155.46 / $292.32	Professional	TC	$93.85	$155.46	$292.32
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $235.18 / $373.28 / $423.50	Professional		$235.18	$373.28	$423.50
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $72.55 / $97.07 / $116.46	Professional	26	$72.55	$97.07	$116.46
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $162.63 / $276.20 / $312.23	Professional	TC	$162.63	$276.20	$312.23