Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $23.99 / $23.99	Facility	26	$23.99	$23.99	$23.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $128.82 / $269.15	Professional		$81.28	$128.82	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $30.90 / $95.50	Professional	26	$22.91	$30.90	$95.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $102.33 / $223.87	Professional	TC	$70.79	$102.33	$223.87
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $128.82 / $154.88	Professional		$33.88	$128.82	$154.88
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $29.51 / $34.67	Professional	26	$26.30	$29.51	$34.67
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $109.65 / $120.23	Professional	TC	$95.50	$109.65	$120.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $44.67 / $44.67	Facility	26	$44.67	$44.67	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $125.89 / $288.40	Professional		$89.13	$125.89	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $30.90 / $61.66	Professional	26	$21.88	$30.90	$61.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $97.72 / $223.87	Professional	TC	$67.61	$97.72	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $154.88 / $213.80	Professional		$131.83	$154.88	$213.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $32.36 / $44.67	Professional	26	$29.51	$32.36	$44.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $123.03 / $169.82	Professional	TC	$104.71	$123.03	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $120.23 / $218.78	Professional		$87.10	$120.23	$218.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $30.20 / $51.29	Professional	26	$21.38	$30.20	$51.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $93.33 / $169.82	Professional	TC	$64.57	$93.33	$169.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $162.18 / $213.80	Professional		$81.28	$162.18	$213.80
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $33.88 / $42.66	Professional	26	$17.78	$33.88	$42.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $128.82 / $173.78	Professional	TC	$63.10	$128.82	$173.78