Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.54 / $96.34 / $237.05	Professional		$78.54	$96.34	$237.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.32 / $19.45 / $45.95	Professional	26	$17.32	$19.45	$45.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.57 / $71.13 / $189.58	Professional	TC	$55.57	$71.13	$189.58
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $88.71 / $103.26 / $131.13	Professional		$88.71	$103.26	$131.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $20.55 / $22.83 / $28.99	Professional	26	$20.55	$22.83	$28.99
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $65.88 / $80.43 / $102.15	Professional	TC	$65.88	$80.43	$102.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.50 / $103.45 / $199.38	Professional		$76.50	$103.45	$199.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.56 / $23.61 / $46.08	Professional	26	$15.56	$23.61	$46.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.68 / $80.09 / $176.41	Professional	TC	$57.68	$80.09	$176.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $101.68 / $122.87 / $172.13	Professional		$101.68	$122.87	$172.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.05 / $23.46 / $32.72	Professional	26	$20.05	$23.46	$32.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.53 / $98.51 / $139.41	Professional	TC	$81.53	$98.51	$139.41
United Facility/Professional Professional Modifier Low / Median / High Price $67.62 / $92.69 / $173.22	Professional		$67.62	$92.69	$173.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.66 / $20.44 / $36.02	Professional	26	$15.66	$20.44	$36.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $51.92 / $72.84 / $130.21	Professional	TC	$51.92	$72.84	$130.21
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.81 / $111.92 / $145.26	Professional		$69.81	$111.92	$145.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.85 / $21.60 / $29.46	Professional	26	$13.85	$21.60	$29.46
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $55.97 / $90.59 / $115.80	Professional	TC	$55.97	$90.59	$115.80