Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $289.30 / $867.89 / $961.80	Facility		$289.30	$867.89	$961.80
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $353.69 / $353.69 / $353.69	Facility	TC	$353.69	$353.69	$353.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.72 / $77.05 / $360.00	Professional		$42.72	$77.05	$360.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.12 / $40.88 / $432.61	Professional	26	$17.12	$40.88	$432.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.64 / $47.70 / $127.83	Professional	TC	$28.64	$47.70	$127.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $79.42 / $88.25 / $112.08	Professional		$79.42	$88.25	$112.08
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $28.03 / $31.14 / $38.47	Professional	26	$28.03	$31.14	$38.47
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $53.99 / $57.11 / $72.53	Professional	TC	$53.99	$57.11	$72.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.04 / $49.04 / $124.16	Professional		$29.04	$49.04	$124.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $14.76 / $38.38	Professional	26	$9.11	$14.76	$38.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.92 / $35.36 / $85.58	Professional	TC	$19.92	$35.36	$85.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $99.80 / $119.76 / $158.02	Professional		$99.80	$119.76	$158.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.62 / $33.14 / $45.15	Professional	26	$27.62	$33.14	$45.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.18 / $86.62 / $115.33	Professional	TC	$72.18	$86.62	$115.33
United Facility/Professional Professional Modifier Low / Median / High Price $46.04 / $75.34 / $147.13	Professional		$46.04	$75.34	$147.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.46 / $21.24 / $44.61	Professional	26	$14.46	$21.24	$44.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.65 / $51.27 / $83.98	Professional	TC	$30.65	$51.27	$83.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $81.09 / $125.33 / $142.34	Professional		$81.09	$125.33	$142.34
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $24.94 / $33.53 / $40.29	Professional	26	$24.94	$33.53	$40.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $56.16 / $91.78 / $103.75	Professional	TC	$56.16	$91.78	$103.75