Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $211.79 / $887.04 / $1,766.20	Facility		$211.79	$887.04	$1,766.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.59 / $41.59 / $44.62	Facility	26	$41.59	$41.59	$44.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.83 / $204.21 / $814.00	Professional		$170.83	$204.21	$814.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.83 / $37.29 / $92.88	Professional	26	$30.83	$37.29	$92.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.16 / $169.56 / $402.44	Professional	TC	$136.16	$169.56	$402.44
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $181.31 / $201.46 / $294.13	Professional		$181.31	$201.46	$294.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $32.97 / $34.86 / $51.49	Professional	26	$32.97	$34.86	$51.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $149.93 / $166.59 / $243.22	Professional	TC	$149.93	$166.59	$243.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $196.06 / $196.06 / $196.06	Facility		$196.06	$196.06	$196.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $174.86 / $259.41 / $409.76	Professional		$174.86	$259.41	$409.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.70 / $46.53 / $82.77	Professional	26	$31.70	$46.53	$82.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.10 / $219.40 / $337.64	Professional	TC	$138.10	$219.40	$337.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $187.22 / $241.51 / $342.55	Professional		$187.22	$241.51	$342.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.29 / $49.72 / $64.30	Professional	26	$38.29	$49.72	$64.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $148.07 / $191.01 / $278.25	Professional	TC	$148.07	$191.01	$278.25
United Facility/Professional Facility Modifier Low / Median / High Price $24.30 / $104.39 / $258.56	Facility		$24.30	$104.39	$258.56
United Facility/Professional Professional Modifier Low / Median / High Price $167.26 / $241.33 / $397.23	Professional		$167.26	$241.33	$397.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.34 / $40.42 / $81.59	Professional	26	$27.34	$40.42	$81.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.90 / $204.53 / $377.25	Professional	TC	$132.90	$204.53	$377.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $152.80 / $215.30 / $264.98	Professional		$152.80	$215.30	$264.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.95 / $45.02 / $55.79	Professional	26	$31.95	$45.02	$55.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $120.85 / $170.28 / $212.50	Professional	TC	$120.85	$170.28	$212.50