Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $289.30 / $289.30 / $289.30	Facility		$289.30	$289.30	$289.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.84 / $135.46 / $363.03	Professional		$73.84	$135.46	$363.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.79 / $31.16 / $81.02	Professional	26	$25.79	$31.16	$81.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.05 / $106.36 / $285.04	Professional	TC	$48.05	$106.36	$285.04
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $154.13 / $167.35 / $212.53	Professional		$154.13	$167.35	$212.53
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.00 / $42.22 / $53.62	Professional	26	$38.00	$42.22	$53.62
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $118.56 / $125.13 / $154.56	Professional	TC	$118.56	$125.13	$154.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.16 / $94.47 / $222.15	Professional		$50.16	$94.47	$222.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.21 / $21.13 / $60.01	Professional	26	$16.21	$21.13	$60.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.45 / $73.23 / $162.63	Professional	TC	$33.45	$73.23	$162.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $178.98 / $214.78 / $284.14	Professional		$178.98	$214.78	$284.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.68 / $45.22 / $57.72	Professional	26	$37.68	$45.22	$57.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $141.30 / $169.56 / $226.42	Professional	TC	$141.30	$169.56	$226.42
United Facility/Professional Professional Modifier Low / Median / High Price $79.58 / $136.12 / $323.99	Professional		$79.58	$136.12	$323.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.72 / $32.04 / $60.09	Professional	26	$25.72	$32.04	$60.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.07 / $107.42 / $243.61	Professional	TC	$53.07	$107.42	$243.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $150.43 / $225.35 / $254.75	Professional		$150.43	$225.35	$254.75
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.67 / $45.78 / $55.04	Professional	26	$33.67	$45.78	$55.04
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $116.76 / $179.57 / $203.00	Professional	TC	$116.76	$179.57	$203.00