Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $456.39 / $775.01 / $988.91	Facility		$456.39	$775.01	$988.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.86 / $125.85 / $536.00	Professional		$103.86	$125.85	$536.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.50 / $22.82 / $59.74	Professional	26	$20.50	$22.82	$59.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.78 / $105.31 / $269.83	Professional	TC	$89.78	$105.31	$269.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $124.04 / $128.87 / $188.15	Professional		$124.04	$128.87	$188.15
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $22.68 / $23.37 / $35.03	Professional	26	$22.68	$23.37	$35.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $101.37 / $105.50 / $154.03	Professional	TC	$101.37	$105.50	$154.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $142.55 / $142.55 / $142.55	Facility		$142.55	$142.55	$142.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.71 / $174.19 / $268.55	Professional		$113.71	$174.19	$268.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.47 / $29.71 / $51.69	Professional	26	$20.47	$29.71	$51.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.08 / $149.04 / $235.19	Professional	TC	$91.08	$149.04	$235.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $121.28 / $156.44 / $221.26	Professional		$121.28	$156.44	$221.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.16 / $29.85 / $39.39	Professional	26	$23.16	$29.85	$39.39
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.78 / $126.14 / $182.15	Professional	TC	$97.78	$126.14	$182.15
United Facility/Professional Facility Modifier Low / Median / High Price $16.73 / $75.72 / $201.87	Facility		$16.73	$75.72	$201.87
United Facility/Professional Professional Modifier Low / Median / High Price $107.61 / $156.77 / $255.72	Professional		$107.61	$156.77	$255.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.95 / $26.82 / $55.85	Professional	26	$17.95	$26.82	$55.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.11 / $131.55 / $237.15	Professional	TC	$86.11	$131.55	$237.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $95.93 / $139.47 / $172.03	Professional		$95.93	$139.47	$172.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $18.59 / $27.03 / $33.81	Professional	26	$18.59	$27.03	$33.81
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $77.34 / $112.45 / $140.32	Professional	TC	$77.34	$112.45	$140.32