Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $155.97 / $852.00 / $1,316.80	Facility		$155.97	$852.00	$1,316.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.57 / $26.27 / $28.66	Facility	26	$20.57	$26.27	$28.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.78 / $141.84 / $565.00	Professional		$107.78	$141.84	$565.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $24.69 / $106.00	Professional	26	$18.45	$24.69	$106.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $206.46 / $206.46 / $206.46	Professional	50	$206.46	$206.46	$206.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.37 / $112.49 / $274.24	Professional	TC	$99.37	$112.49	$274.24
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $126.44 / $144.99 / $211.69	Professional		$126.44	$144.99	$211.69
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $19.48 / $20.74 / $30.39	Professional	26	$19.48	$20.74	$30.39
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $105.70 / $124.25 / $181.41	Professional	TC	$105.70	$124.25	$181.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $176.47 / $176.47 / $176.47	Facility		$176.47	$176.47	$176.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $136.55 / $207.32 / $324.80	Professional		$136.55	$207.32	$324.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.10 / $27.86 / $50.02	Professional	26	$19.10	$27.86	$50.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $116.57 / $186.73 / $277.77	Professional	TC	$116.57	$186.73	$277.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.78 / $190.64 / $273.12	Professional		$147.78	$190.64	$273.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.44 / $28.85 / $38.47	Professional	26	$22.44	$28.85	$38.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.06 / $160.50 / $234.62	Professional	TC	$125.06	$160.50	$234.62
United Facility/Professional Professional Modifier Low / Median / High Price $128.72 / $193.07 / $317.00	Professional		$128.72	$193.07	$317.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.14 / $25.22 / $57.57	Professional	26	$16.14	$25.22	$57.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.54 / $166.03 / $278.29	Professional	TC	$109.54	$166.03	$278.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $108.47 / $158.32 / $195.59	Professional		$108.47	$158.32	$195.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $17.89 / $26.13 / $32.85	Professional	26	$17.89	$26.13	$32.85
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $90.56 / $132.18 / $164.88	Professional	TC	$90.56	$132.18	$164.88