Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $660.69 / $660.69 / $676.08	Facility		$660.69	$660.69	$676.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $138.04 / $346.74	Professional		$102.33	$138.04	$346.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $25.12 / $53.70	Professional	26	$15.14	$25.12	$53.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $114.82 / $229.09	Professional	TC	$91.20	$114.82	$229.09
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $147.91 / $204.17	Professional		$30.90	$147.91	$204.17
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $21.38 / $28.84	Professional	26	$19.50	$21.38	$28.84
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $128.82 / $177.83	Professional	TC	$114.82	$128.82	$177.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Facility		$204.17	$204.17	$204.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.62 / $26.30 / $37.15	Facility	26	$5.62	$26.30	$37.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $199.53 / $323.59	Professional		$131.83	$199.53	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $25.12 / $45.71	Professional	26	$13.80	$25.12	$45.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $173.78 / $281.84	Professional	TC	$120.23	$173.78	$281.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $169.82 / $234.42	Professional		$123.03	$169.82	$234.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $24.55 / $35.48	Professional	26	$16.98	$24.55	$35.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $144.54 / $199.53	Professional	TC	$104.71	$144.54	$199.53
United Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $114.82 / $134.90	Facility		$19.95	$114.82	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $190.55 / $309.03	Professional		$134.90	$190.55	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $23.99 / $42.66	Professional	26	$11.48	$23.99	$42.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $165.96 / $281.84	Professional	TC	$114.82	$165.96	$281.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $158.49 / $213.80	Professional		$109.65	$158.49	$213.80
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $26.92 / $34.67	Professional	26	$18.20	$26.92	$34.67
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $131.83 / $177.83	Professional	TC	$91.20	$131.83	$177.83