Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.65 / $242.44 / $275.20	Professional		$128.65	$242.44	$275.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.06 / $34.53 / $38.82	Professional	26	$29.06	$34.53	$38.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.59 / $210.64 / $240.67	Professional	TC	$99.59	$210.64	$240.67
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $298.64 / $315.19 / $400.29	Professional		$298.64	$315.19	$400.29
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $42.87 / $47.63 / $60.49	Professional	26	$42.87	$47.63	$60.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $253.52 / $267.56 / $339.80	Professional	TC	$253.52	$267.56	$339.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $88.10 / $184.58 / $407.25	Professional		$88.10	$184.58	$407.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.54 / $24.17 / $67.27	Professional	26	$17.54	$24.17	$67.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.36 / $160.10 / $358.43	Professional	TC	$69.36	$160.10	$358.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $283.36 / $340.03 / $456.61	Professional		$283.36	$340.03	$456.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.52 / $48.62 / $61.76	Professional	26	$40.52	$48.62	$61.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $242.84 / $291.41 / $396.91	Professional	TC	$242.84	$291.41	$396.91
United Facility/Professional Professional Modifier Low / Median / High Price $145.44 / $273.60 / $452.74	Professional		$145.44	$273.60	$452.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $37.15 / $91.50	Professional	26	$28.84	$37.15	$91.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.75 / $239.75 / $453.10	Professional	TC	$115.75	$239.75	$453.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $286.20 / $357.57 / $404.21	Professional		$286.20	$357.57	$404.21
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.29 / $48.98 / $59.45	Professional	26	$38.29	$48.98	$59.45
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $247.91 / $308.58 / $348.84	Professional	TC	$247.91	$308.58	$348.84