Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $169.82 / $524.81	Professional		$107.15	$169.82	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $69.18 / $186.21	Professional	26	$52.48	$69.18	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $64.57 / $173.78	Professional	TC	$52.48	$64.57	$173.78
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $128.82 / $165.96	Professional		$56.23	$128.82	$165.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $61.66 / $70.79	Professional	26	$58.88	$61.66	$70.79
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $67.61 / $114.82	Professional	TC	$60.26	$67.61	$114.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $95.50 / $95.50	Facility	26	$95.50	$95.50	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $181.97 / $302.00	Professional		$112.20	$181.97	$302.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $74.13 / $131.83	Professional	26	$54.95	$74.13	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $107.15 / $204.17	Professional	TC	$56.23	$107.15	$204.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $147.91 / $208.93	Professional		$128.82	$147.91	$208.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $70.79 / $100.00	Professional	26	$61.66	$70.79	$100.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $77.62 / $134.90	Professional	TC	$66.07	$77.62	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $169.82 / $269.15	Professional		$112.20	$169.82	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $69.18 / $123.03	Professional	26	$50.12	$69.18	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $100.00 / $158.49	Professional	TC	$56.23	$100.00	$158.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $158.49 / $186.21	Professional		$120.23	$158.49	$186.21
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $75.86 / $89.13	Professional	26	$58.88	$75.86	$89.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $83.18 / $95.50	Professional	TC	$60.26	$83.18	$95.50