Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $162.18 / $446.68	Professional		$125.89	$162.18	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $52.48 / $154.88	Professional	26	$38.90	$52.48	$154.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $107.15 / $263.03	Professional	TC	$85.11	$107.15	$263.03
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $151.36 / $257.04	Professional		$114.82	$151.36	$257.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $45.71 / $57.54	Professional	26	$40.74	$45.71	$57.54
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $107.15 / $144.54	Professional	TC	$95.50	$107.15	$144.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $70.79 / $70.79	Facility	26	$70.79	$70.79	$70.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $199.53 / $323.59	Professional		$131.83	$199.53	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $58.88 / $104.71	Professional	26	$41.69	$58.88	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $141.25 / $234.42	Professional	TC	$91.20	$141.25	$234.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $169.82 / $257.04	Professional		$147.91	$169.82	$257.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $51.29 / $75.86	Professional	26	$43.65	$51.29	$75.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $120.23 / $181.97	Professional	TC	$102.33	$120.23	$181.97
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $177.83 / $288.40	Professional		$128.82	$177.83	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $51.29 / $87.10	Professional	26	$38.02	$51.29	$87.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $123.03 / $204.17	Professional	TC	$87.10	$123.03	$204.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $181.97 / $213.80	Professional		$128.82	$181.97	$213.80
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $53.70 / $64.57	Professional	26	$39.81	$53.70	$64.57
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $128.82 / $151.36	Professional	TC	$89.13	$128.82	$151.36