Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.57 / $34.28 / $38.86	Facility	26	$28.57	$34.28	$38.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.61 / $110.97 / $400.00	Professional		$97.61	$110.97	$400.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.57 / $32.64 / $114.70	Professional	26	$28.57	$32.64	$114.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.13 / $78.00 / $141.40	Professional	TC	$68.13	$78.00	$141.40
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $117.53 / $130.58 / $149.26	Professional		$117.53	$130.58	$149.26
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $35.40 / $39.34 / $44.97	Professional	26	$35.40	$39.34	$44.97
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $82.12 / $91.24 / $104.29	Professional	TC	$82.12	$91.24	$104.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $86.37 / $128.09 / $247.11	Professional		$86.37	$128.09	$247.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.82 / $39.24 / $77.28	Professional	26	$25.82	$39.24	$77.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.59 / $94.41 / $171.80	Professional	TC	$60.59	$94.41	$171.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $111.64 / $134.01 / $198.54	Professional		$111.64	$134.01	$198.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.97 / $38.59 / $54.81	Professional	26	$32.97	$38.59	$54.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.08 / $94.24 / $143.72	Professional	TC	$78.08	$94.24	$143.72
United Facility/Professional Professional Modifier Low / Median / High Price $89.52 / $110.43 / $193.77	Professional		$89.52	$110.43	$193.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.76 / $35.72 / $61.00	Professional	26	$26.76	$35.72	$61.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.76 / $76.84 / $132.77	Professional	TC	$59.76	$76.84	$132.77
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $89.63 / $121.83 / $159.47	Professional		$89.63	$121.83	$159.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.81 / $35.63 / $48.59	Professional	26	$26.81	$35.63	$48.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $62.82 / $86.75 / $110.90	Professional	TC	$62.82	$86.75	$110.90