Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.57 / $22.57 / $22.57	Facility	26	$22.57	$22.57	$22.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.06 / $103.31 / $482.63	Professional		$86.06	$103.31	$482.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.57 / $28.36 / $89.64	Professional	26	$22.57	$28.36	$89.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.40 / $73.22 / $194.46	Professional	TC	$61.40	$73.22	$194.46
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $102.88 / $114.31 / $129.35	Professional		$102.88	$114.31	$129.35
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $28.03 / $31.14 / $35.60	Professional	26	$28.03	$31.14	$35.60
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $72.61 / $83.17 / $94.11	Professional	TC	$72.61	$83.17	$94.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.31 / $119.09 / $236.20	Professional		$80.31	$119.09	$236.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.10 / $31.06 / $58.07	Professional	26	$20.10	$31.06	$58.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.78 / $88.59 / $180.71	Professional	TC	$57.78	$88.59	$180.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $110.85 / $133.05 / $193.74	Professional		$110.85	$133.05	$193.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.90 / $31.25 / $43.84	Professional	26	$25.90	$31.25	$43.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $84.81 / $103.06 / $149.88	Professional	TC	$84.81	$103.06	$149.88
United Facility/Professional Professional Modifier Low / Median / High Price $81.76 / $115.85 / $212.99	Professional		$81.76	$115.85	$212.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.05 / $28.16 / $50.26	Professional	26	$20.05	$28.16	$50.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.29 / $88.09 / $170.50	Professional	TC	$63.29	$88.09	$170.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $82.20 / $127.48 / $157.56	Professional		$82.20	$127.48	$157.56
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $19.30 / $29.95 / $37.79	Professional	26	$19.30	$29.95	$37.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $62.89 / $97.53 / $121.80	Professional	TC	$62.89	$97.53	$121.80