Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.43 / $12.43 / $15.04	Facility	26	$12.43	$12.43	$15.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.46 / $69.83 / $293.41	Professional		$55.46	$69.83	$293.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.43 / $17.14 / $48.21	Professional	26	$12.43	$17.14	$48.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.15 / $50.08 / $137.13	Professional	TC	$41.15	$50.08	$137.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $67.73 / $75.26 / $95.58	Professional		$67.73	$75.26	$95.58
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $17.73 / $19.72 / $25.90	Professional	26	$17.73	$19.72	$25.90
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $49.99 / $55.55 / $70.55	Professional	TC	$49.99	$55.55	$70.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.40 / $74.00 / $137.03	Professional		$49.40	$74.00	$137.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.28 / $19.21 / $37.82	Professional	26	$11.28	$19.21	$37.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.82 / $55.07 / $107.90	Professional	TC	$37.82	$55.07	$107.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.52 / $77.42 / $108.97	Professional		$64.52	$77.42	$108.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.49 / $18.80 / $30.50	Professional	26	$14.49	$18.80	$30.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $49.94 / $59.54 / $85.76	Professional	TC	$49.94	$59.54	$85.76
United Facility/Professional Professional Modifier Low / Median / High Price $49.61 / $61.69 / $106.07	Professional		$49.61	$61.69	$106.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.42 / $16.32 / $31.43	Professional	26	$12.42	$16.32	$31.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.54 / $45.40 / $79.59	Professional	TC	$36.54	$45.40	$79.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $50.58 / $70.38 / $91.57	Professional		$50.58	$70.38	$91.57
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.43 / $15.47 / $21.09	Professional	26	$11.43	$15.47	$21.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $39.15 / $55.13 / $70.47	Professional	TC	$39.15	$55.13	$70.47