Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.67 / $14.67 / $14.67	Facility	26	$14.67	$14.67	$14.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.64 / $74.09 / $188.21	Professional		$61.64	$74.09	$188.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.67 / $16.30 / $39.31	Professional	26	$14.67	$16.30	$39.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.00 / $55.56 / $118.72	Professional	TC	$46.00	$55.56	$118.72
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $74.56 / $82.69 / $105.02	Professional		$74.56	$82.69	$105.02
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $17.73 / $19.71 / $25.03	Professional	26	$17.73	$19.71	$25.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $54.86 / $62.98 / $79.98	Professional	TC	$54.86	$62.98	$79.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.60 / $89.01 / $185.18	Professional		$60.60	$89.01	$185.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.28 / $20.14 / $39.81	Professional	26	$13.28	$20.14	$39.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.03 / $66.42 / $139.10	Professional	TC	$47.03	$66.42	$139.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $82.73 / $99.90 / $139.34	Professional		$82.73	$99.90	$139.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.04 / $19.94 / $28.30	Professional	26	$17.04	$19.94	$28.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $65.56 / $79.26 / $111.04	Professional	TC	$65.56	$79.26	$111.04
United Facility/Professional Professional Modifier Low / Median / High Price $56.52 / $79.76 / $168.13	Professional		$56.52	$79.76	$168.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $18.77 / $32.15	Professional	26	$13.49	$18.77	$32.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.01 / $60.35 / $109.88	Professional	TC	$43.01	$60.35	$109.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $58.70 / $90.99 / $118.19	Professional		$58.70	$90.99	$118.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $12.13 / $18.37 / $25.05	Professional	26	$12.13	$18.37	$25.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $46.57 / $72.86 / $93.14	Professional	TC	$46.57	$72.86	$93.14