Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.26 / $143.56 / $282.08	Facility	26	$32.26	$143.56	$282.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.65 / $90.75 / $192.75	Professional		$79.65	$90.75	$192.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.26 / $34.90 / $78.13	Professional	26	$32.26	$34.90	$78.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.02 / $47.40 / $114.70	Professional	TC	$47.02	$47.40	$114.70
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $97.13 / $97.13 / $295.73	Professional		$97.13	$97.13	$295.73
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $41.70 / $41.70 / $100.45	Professional	26	$41.70	$41.70	$100.45
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $55.43 / $55.43 / $141.15	Professional	TC	$55.43	$55.43	$141.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.29 / $117.65 / $272.45	Professional		$74.29	$117.65	$272.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.61 / $44.19 / $117.17	Professional	26	$30.61	$44.19	$117.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.00 / $69.95 / $155.29	Professional	TC	$42.00	$69.95	$155.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $88.47 / $105.27 / $200.18	Professional		$88.47	$105.27	$200.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.36 / $42.09 / $80.05	Professional	26	$36.36	$42.09	$80.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $52.11 / $63.17 / $120.15	Professional	TC	$52.11	$63.17	$120.15
United Facility/Professional Professional Modifier Low / Median / High Price $75.70 / $113.93 / $275.55	Professional		$75.70	$113.93	$275.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.59 / $41.38 / $115.99	Professional	26	$29.59	$41.38	$115.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.95 / $51.50 / $165.36	Professional	TC	$44.95	$51.50	$165.36