Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.17 / $27.81 / $31.41	Facility	26	$23.17	$27.81	$31.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.57 / $121.55 / $311.70	Professional		$97.57	$121.55	$311.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.18 / $24.84 / $72.39	Professional	26	$23.18	$24.84	$72.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.98 / $104.00 / $239.32	Professional	TC	$73.98	$104.00	$239.32
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $118.20 / $138.21 / $175.53	Professional		$118.20	$138.21	$175.53
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $26.44 / $29.38 / $37.31	Professional	26	$26.44	$29.38	$37.31
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $88.82 / $108.83 / $138.21	Professional	TC	$88.82	$108.83	$138.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.20 / $132.40 / $295.67	Professional		$95.20	$132.40	$295.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.80 / $31.17 / $59.90	Professional	26	$20.80	$31.17	$59.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.47 / $105.15 / $234.95	Professional	TC	$73.47	$105.15	$234.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.13 / $158.99 / $231.28	Professional		$125.13	$158.99	$231.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.04 / $31.60 / $45.86	Professional	26	$27.04	$31.60	$45.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $96.45 / $128.25 / $177.46	Professional	TC	$96.45	$128.25	$177.46
United Facility/Professional Professional Modifier Low / Median / High Price $87.11 / $125.37 / $277.43	Professional		$87.11	$125.37	$277.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.95 / $28.15 / $48.76	Professional	26	$20.95	$28.15	$48.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.16 / $94.19 / $176.37	Professional	TC	$66.16	$94.19	$176.37
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $85.06 / $147.21 / $191.09	Professional		$85.06	$147.21	$191.09
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $17.13 / $28.80 / $39.27	Professional	26	$17.13	$28.80	$39.27
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $67.93 / $118.75 / $151.82	Professional	TC	$67.93	$118.75	$151.82