Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $288.40 / $724.44	Facility		$154.88	$288.40	$724.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $75.86 / $83.18	Facility	26	$61.66	$75.86	$83.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $323.59 / $851.14	Professional		$181.97	$323.59	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $77.62 / $245.47	Professional	26	$63.10	$77.62	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $186.21 / $512.86	Professional	TC	$123.03	$186.21	$512.86
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $218.78 / $380.19	Professional		$138.04	$218.78	$380.19
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $70.79 / $95.50	Professional	26	$64.57	$70.79	$95.50
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $144.54 / $234.42	Professional	TC	$131.83	$144.54	$234.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Facility		$302.00	$302.00	$302.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $295.12 / $524.81	Professional		$190.55	$295.12	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $87.10 / $162.18	Professional	26	$64.57	$87.10	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $213.80 / $354.81	Professional	TC	$134.90	$213.80	$354.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $245.47 / $380.19	Professional		$208.93	$245.47	$380.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $81.28 / $114.82	Professional	26	$69.18	$81.28	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $165.96 / $281.84	Professional	TC	$138.04	$165.96	$281.84
United Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $165.96 / $234.42	Facility		$57.54	$165.96	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $269.15 / $436.52	Professional		$190.55	$269.15	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $79.43 / $144.54	Professional	26	$58.88	$79.43	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $186.21 / $302.00	Professional	TC	$123.03	$186.21	$302.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $257.04 / $302.00	Professional		$199.53	$257.04	$302.00
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $85.11 / $102.33	Professional	26	$67.61	$85.11	$102.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $173.78 / $204.17	Professional	TC	$131.83	$173.78	$204.17