Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.73 / $93.77 / $251.30	Professional		$45.73	$93.77	$251.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $23.55 / $236.05	Professional	26	$18.48	$23.55	$236.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.26 / $71.75 / $192.29	Professional	TC	$27.26	$71.75	$192.29
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $104.95 / $116.61 / $148.09	Professional		$104.95	$116.61	$148.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $29.01 / $32.22 / $40.93	Professional	26	$29.01	$32.22	$40.93
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $75.94 / $84.38 / $104.22	Professional	TC	$75.94	$84.38	$104.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1.25 / $53.86 / $127.18	Professional		$1.25	$53.86	$127.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $0.32 / $15.40 / $42.84	Professional	26	$0.32	$15.40	$42.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $0.95 / $39.26 / $89.48	Professional	TC	$0.95	$39.26	$89.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.46 / $137.35 / $181.29	Professional		$114.46	$137.35	$181.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.26 / $33.90 / $43.21	Professional	26	$28.26	$33.90	$43.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $103.44 / $138.19	Professional	TC	$86.20	$103.44	$138.19
United Facility/Professional Professional Modifier Low / Median / High Price $47.57 / $72.40 / $141.29	Professional		$47.57	$72.40	$141.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.37 / $23.79 / $48.71	Professional	26	$18.37	$23.79	$48.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.00 / $50.71 / $95.81	Professional	TC	$31.00	$50.71	$95.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $67.23 / $143.78 / $163.02	Professional		$67.23	$143.78	$163.02
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $24.88 / $34.27 / $41.28	Professional	26	$24.88	$34.27	$41.28
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $42.35 / $109.51 / $123.80	Professional	TC	$42.35	$109.51	$123.80