Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.27 / $151.72 / $421.78	Professional		$128.27	$151.72	$421.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.11 / $45.28 / $110.09	Professional	26	$39.11	$45.28	$110.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.15 / $106.60 / $296.33	Professional	TC	$89.15	$106.60	$296.33
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $131.84 / $146.58 / $214.01	Professional		$131.84	$146.58	$214.01
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $43.81 / $48.68 / $67.91	Professional	26	$43.81	$48.68	$67.91
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $83.16 / $97.90 / $150.33	Professional	TC	$83.16	$97.90	$150.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $130.38 / $204.34 / $337.25	Professional		$130.38	$204.34	$337.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.12 / $60.36 / $113.65	Professional	26	$42.12	$60.36	$113.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.21 / $145.83 / $250.94	Professional	TC	$91.21	$145.83	$250.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $139.87 / $180.43 / $291.89	Professional		$139.87	$180.43	$291.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.13 / $54.78 / $87.89	Professional	26	$43.13	$54.78	$87.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $96.74 / $124.79 / $204.00	Professional	TC	$96.74	$124.79	$204.00
United Facility/Professional Professional Modifier Low / Median / High Price $124.61 / $177.09 / $296.05	Professional		$124.61	$177.09	$296.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.95 / $52.02 / $91.96	Professional	26	$36.95	$52.02	$91.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.79 / $123.53 / $229.58	Professional	TC	$85.79	$123.53	$229.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $127.94 / $160.85 / $199.37	Professional		$127.94	$160.85	$199.37
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.46 / $49.60 / $62.86	Professional	26	$39.46	$49.60	$62.86
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $88.48 / $111.25 / $138.83	Professional	TC	$88.48	$111.25	$138.83