Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.09 / $121.42 / $140.06	Facility	26	$94.09	$121.42	$140.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.19 / $189.31 / $399.79	Professional		$164.19	$189.31	$399.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.10 / $107.31 / $223.00	Professional	26	$94.10	$107.31	$223.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.17 / $79.70 / $129.52	Professional	TC	$68.17	$79.70	$129.52
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $156.02 / $173.36 / $312.04	Professional		$156.02	$173.36	$312.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $86.84 / $96.49 / $173.68	Professional	26	$86.84	$96.49	$173.68
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $69.19 / $76.87 / $138.38	Professional	TC	$69.19	$76.87	$138.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.17 / $231.13 / $432.56	Professional		$111.17	$231.13	$432.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.70 / $146.62 / $266.70	Professional	26	$92.70	$146.62	$266.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.27 / $112.42 / $196.40	Professional	TC	$62.27	$112.42	$196.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $133.37 / $195.60 / $266.73	Professional		$133.37	$195.60	$266.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $78.39 / $114.97 / $156.78	Professional	26	$78.39	$114.97	$156.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.98 / $80.95 / $109.95	Professional	TC	$54.98	$80.95	$109.95
United Facility/Professional Professional Modifier Low / Median / High Price $157.16 / $235.75 / $456.47	Professional		$157.16	$235.75	$456.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.44 / $126.41 / $241.86	Professional	26	$86.44	$126.41	$241.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.98 / $101.81 / $163.96	Professional	TC	$68.98	$101.81	$163.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $157.09 / $204.23 / $255.29	Professional		$157.09	$204.23	$255.29
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $92.34 / $120.20 / $151.79	Professional	26	$92.34	$120.20	$151.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $64.75 / $82.80 / $103.50	Professional	TC	$64.75	$82.80	$103.50