Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $125.89 / $288.40	Professional		$104.71	$125.89	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $56.23 / $257.04	Professional	26	$32.36	$56.23	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $93.33 / $204.17	Professional	TC	$64.57	$93.33	$204.17
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $138.04 / $199.53	Professional		$93.33	$138.04	$199.53
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $38.90 / $75.86	Professional	26	$35.48	$38.90	$75.86
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $114.82 / $134.90	Professional	TC	$100.00	$114.82	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1.70 / $83.18 / $269.15	Professional		$1.70	$83.18	$269.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $0.45 / $23.99 / $83.18	Professional	26	$0.45	$23.99	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1.26 / $57.54 / $186.21	Professional	TC	$1.26	$57.54	$186.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $186.21 / $245.47	Professional		$154.88	$186.21	$245.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $50.12 / $63.10	Professional	26	$41.69	$50.12	$63.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $138.04 / $177.83	Professional	TC	$114.82	$138.04	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $134.90 / $275.42	Professional		$93.33	$134.90	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $41.69 / $77.62	Professional	26	$28.18	$41.69	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $93.33 / $194.98	Professional	TC	$64.57	$93.33	$194.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $218.78 / $245.47	Professional		$114.82	$218.78	$245.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $56.23 / $63.10	Professional	26	$37.15	$56.23	$63.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $162.18 / $181.97	Professional	TC	$77.62	$162.18	$181.97