Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $129.16 / $289.30 / $732.06	Facility		$129.16	$289.30	$732.06
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $80.73 / $80.73 / $80.73	Facility	TC	$80.73	$80.73	$80.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.14 / $89.14 / $271.00	Professional		$61.14	$89.14	$271.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.32 / $34.85 / $221.51	Professional	26	$24.32	$34.85	$221.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.97 / $56.09 / $158.09	Professional	TC	$34.97	$56.09	$158.09
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $69.30 / $105.42 / $133.88	Professional		$69.30	$105.42	$133.88
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.38 / $38.38 / $56.03	Professional	26	$38.38	$38.38	$56.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $16.51 / $67.04 / $85.14	Professional	TC	$16.51	$67.04	$85.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.56 / $57.37 / $183.36	Professional		$39.56	$57.37	$183.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $0.39 / $20.11 / $66.98	Professional	26	$0.39	$20.11	$66.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $0.91 / $39.21 / $120.42	Professional	TC	$0.91	$39.21	$120.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $116.35 / $139.55 / $181.18	Professional		$116.35	$139.55	$181.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $41.26 / $71.88	Professional	26	$33.97	$41.26	$71.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.37 / $98.84 / $125.23	Professional	TC	$82.37	$98.84	$125.23
United Facility/Professional Professional Modifier Low / Median / High Price $68.34 / $85.54 / $216.43	Professional		$68.34	$85.54	$216.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.37 / $31.57 / $58.63	Professional	26	$24.37	$31.57	$58.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.79 / $56.30 / $105.57	Professional	TC	$40.79	$56.30	$105.57
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $93.16 / $145.88 / $165.95	Professional		$93.16	$145.88	$165.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.99 / $41.26 / $49.64	Professional	26	$30.99	$41.26	$49.64
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $62.17 / $104.64 / $118.29	Professional	TC	$62.17	$104.64	$118.29