Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.38 / $101.67 / $246.04	Professional		$87.38	$101.67	$246.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.34 / $27.00 / $65.34	Professional	26	$25.34	$27.00	$65.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.14 / $74.67 / $180.70	Professional	TC	$61.14	$74.67	$180.70
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $112.32 / $112.32 / $244.05	Professional		$112.32	$112.32	$244.05
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $34.79 / $36.90 / $78.51	Professional	26	$34.79	$36.90	$78.51
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $75.41 / $75.41 / $165.54	Professional	TC	$75.41	$75.41	$165.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.93 / $65.43 / $293.56	Professional		$46.93	$65.43	$293.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.91 / $19.57 / $88.41	Professional	26	$13.91	$19.57	$88.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.02 / $47.21 / $200.01	Professional	TC	$33.02	$47.21	$200.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.88 / $135.46 / $178.16	Professional		$112.88	$135.46	$178.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.18 / $38.61 / $49.04	Professional	26	$32.18	$38.61	$49.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $80.70 / $96.84 / $129.12	Professional	TC	$80.70	$96.84	$129.12
United Facility/Professional Professional Modifier Low / Median / High Price $80.86 / $118.18 / $263.74	Professional		$80.86	$118.18	$263.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.47 / $36.61 / $65.56	Professional	26	$23.47	$36.61	$65.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.18 / $87.02 / $181.11	Professional	TC	$58.18	$87.02	$181.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.22 / $141.30 / $161.00	Professional		$104.22	$141.30	$161.00
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $32.75 / $38.89 / $47.16	Professional	26	$32.75	$38.89	$47.16
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $71.45 / $102.41 / $115.77	Professional	TC	$71.45	$102.41	$115.77