Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $659.75 / $659.75 / $675.64	Facility		$659.75	$659.75	$675.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.01 / $130.71 / $231.22	Professional		$107.01	$130.71	$231.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.57 / $22.66 / $34.54	Professional	26	$12.57	$22.66	$34.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.21 / $109.01 / $190.43	Professional	TC	$91.21	$109.01	$190.43
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $144.33 / $149.58 / $246.81	Professional		$144.33	$149.58	$246.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $13.88 / $21.58 / $33.45	Professional	26	$13.88	$21.58	$33.45
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $124.43 / $128.01 / $211.22	Professional	TC	$124.43	$128.01	$211.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.68 / $147.68 / $147.68	Facility		$147.68	$147.68	$147.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.75 / $26.75 / $26.75	Facility	26	$26.75	$26.75	$26.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $132.74 / $201.13 / $336.99	Professional		$132.74	$201.13	$336.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.53 / $24.41 / $48.05	Professional	26	$13.53	$24.41	$48.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.97 / $176.43 / $292.64	Professional	TC	$117.97	$176.43	$292.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.19 / $173.81 / $280.81	Professional		$128.19	$173.81	$280.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.98 / $25.63 / $39.88	Professional	26	$17.98	$25.63	$39.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $108.22 / $148.16 / $240.95	Professional	TC	$108.22	$148.16	$240.95
United Facility/Professional Professional Modifier Low / Median / High Price $133.40 / $185.18 / $303.11	Professional		$133.40	$185.18	$303.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.36 / $22.82 / $38.83	Professional	26	$11.36	$22.82	$38.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $113.55 / $163.58 / $260.47	Professional	TC	$113.55	$163.58	$260.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $108.86 / $143.30 / $195.41	Professional		$108.86	$143.30	$195.41
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $18.34 / $24.41 / $31.17	Professional	26	$18.34	$24.41	$31.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $90.52 / $118.89 / $162.12	Professional	TC	$90.52	$118.89	$162.12