Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.96 / $202.36 / $819.00	Professional		$183.96	$202.36	$819.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.46 / $35.14 / $92.54	Professional	26	$21.46	$35.14	$92.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $150.72 / $169.96 / $431.74	Professional	TC	$150.72	$169.96	$431.74
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $181.93 / $202.14 / $295.12	Professional		$181.93	$202.14	$295.12
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $24.49 / $34.78 / $50.78	Professional	26	$24.49	$34.78	$50.78
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $155.25 / $167.36 / $244.35	Professional	TC	$155.25	$167.36	$244.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.98 / $272.37 / $446.15	Professional		$190.98	$272.37	$446.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.21 / $41.56 / $82.45	Professional	26	$24.21	$41.56	$82.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $155.63 / $242.68 / $366.76	Professional	TC	$155.63	$242.68	$366.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $205.05 / $264.51 / $375.46	Professional		$205.05	$264.51	$375.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.26 / $45.70 / $64.90	Professional	26	$37.26	$45.70	$64.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $166.98 / $215.40 / $310.56	Professional	TC	$166.98	$215.40	$310.56
United Facility/Professional Professional Modifier Low / Median / High Price $176.51 / $252.16 / $447.25	Professional		$176.51	$252.16	$447.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.42 / $41.55 / $80.83	Professional	26	$19.42	$41.55	$80.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.38 / $213.78 / $352.43	Professional	TC	$148.38	$213.78	$352.43
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $166.72 / $235.81 / $291.08	Professional		$166.72	$235.81	$291.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.96 / $43.79 / $54.92	Professional	26	$30.96	$43.79	$54.92
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $135.76 / $192.03 / $239.55	Professional	TC	$135.76	$192.03	$239.55