Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $281.84 / $724.44	Facility		$128.82	$281.84	$724.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $81.28 / $81.28 / $81.28	Facility	TC	$81.28	$81.28	$81.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $117.49 / $537.03	Professional		$70.79	$117.49	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $72.44 / $363.08	Professional	26	$25.70	$72.44	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $70.79 / $338.84	Professional	TC	$48.98	$70.79	$338.84
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $87.10 / $123.03	Professional		$34.67	$87.10	$123.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $32.36 / $54.95	Professional	26	$28.84	$32.36	$54.95
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $74.13 / $93.33	Professional	TC	$60.26	$74.13	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1.26 / $57.54 / $169.82	Professional		$1.26	$57.54	$169.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $0.39 / $20.42 / $61.66	Professional	26	$0.39	$20.42	$61.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $0.91 / $39.81 / $125.89	Professional	TC	$0.91	$39.81	$125.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $131.83 / $186.21	Professional		$117.49	$131.83	$186.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $42.66 / $72.44	Professional	26	$33.88	$42.66	$72.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $95.50 / $131.83	Professional	TC	$83.18	$95.50	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $85.11 / $190.55	Professional		$67.61	$85.11	$190.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $31.62 / $58.88	Professional	26	$24.55	$31.62	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $58.88 / $125.89	Professional	TC	$41.69	$58.88	$125.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $162.18 / $186.21	Professional		$93.33	$162.18	$186.21
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $46.77 / $51.29	Professional	26	$30.90	$46.77	$51.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $109.65 / $131.83	Professional	TC	$61.66	$109.65	$131.83