Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $204.17 / $489.78	Professional		$181.97	$204.17	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $117.49 / $501.19	Professional	26	$93.33	$117.49	$501.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $102.33 / $234.42	Professional	TC	$79.43	$102.33	$234.42
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $208.93 / $257.04	Professional		$38.02	$208.93	$257.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $112.20 / $128.82	Professional	26	$102.33	$112.20	$128.82
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $123.03 / $138.04	Professional	TC	$109.65	$123.03	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2.63 / $131.83 / $398.11	Professional		$2.63	$131.83	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $1.41 / $70.79 / $208.93	Professional	26	$1.41	$70.79	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1.38 / $63.10 / $204.17	Professional	TC	$1.38	$63.10	$204.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $281.84 / $426.58	Professional		$234.42	$281.84	$426.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $138.04 / $213.80	Professional	26	$114.82	$138.04	$213.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $144.54 / $190.55	Professional	TC	$120.23	$144.54	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $204.17 / $426.58	Professional		$165.96	$204.17	$426.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $112.20 / $204.17	Professional	26	$87.10	$112.20	$204.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $107.15 / $218.78	Professional	TC	$75.86	$107.15	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $331.13 / $371.54	Professional		$223.87	$331.13	$371.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $158.49 / $181.97	Professional	26	$125.89	$158.49	$181.97
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $169.82 / $190.55	Professional	TC	$97.72	$169.82	$190.55