Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $149.10 / $304.01 / $763.92	Facility		$149.10	$304.01	$763.92
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.25 / $79.06 / $121.88	Facility	26	$61.25	$79.06	$121.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.98 / $244.81 / $762.84	Professional		$173.98	$244.81	$762.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.91 / $75.30 / $255.70	Professional	26	$62.91	$75.30	$255.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.48 / $175.12 / $339.62	Professional	TC	$124.48	$175.12	$339.62
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $198.01 / $220.01 / $518.92	Professional		$198.01	$220.01	$518.92
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $60.78 / $67.53 / $159.29	Professional	26	$60.78	$67.53	$159.29
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $137.22 / $152.47 / $359.66	Professional	TC	$137.22	$152.47	$359.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.89 / $302.07 / $612.41	Professional		$189.89	$302.07	$612.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.64 / $92.24 / $173.45	Professional	26	$65.64	$92.24	$173.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $133.00 / $214.48 / $415.82	Professional	TC	$133.00	$214.48	$415.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $200.38 / $258.49 / $380.49	Professional		$200.38	$258.49	$380.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.91 / $85.78 / $114.91	Professional	26	$67.91	$85.78	$114.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $132.38 / $170.77 / $280.99	Professional	TC	$132.38	$170.77	$280.99
United Facility/Professional Professional Modifier Low / Median / High Price $184.64 / $268.13 / $433.90	Professional		$184.64	$268.13	$433.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.68 / $80.81 / $149.80	Professional	26	$58.68	$80.81	$149.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $124.95 / $183.81 / $333.13	Professional	TC	$124.95	$183.81	$333.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $200.38 / $230.44 / $285.98	Professional		$200.38	$230.44	$285.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $68.01 / $78.20 / $99.21	Professional	26	$68.01	$78.20	$99.21
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $132.37 / $152.24 / $189.94	Professional	TC	$132.37	$152.24	$189.94