Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.27 / $27.27 / $35.40	Facility	26	$27.27	$27.27	$35.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.48 / $145.22 / $387.00	Professional		$118.48	$145.22	$387.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.77 / $33.97 / $99.40	Professional	26	$27.77	$33.97	$99.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.61 / $103.68 / $274.43	Professional	TC	$87.61	$103.68	$274.43
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $141.29 / $201.93 / $256.45	Professional		$141.29	$201.93	$256.45
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $32.72 / $36.36 / $46.55	Professional	26	$32.72	$36.36	$46.55
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $104.92 / $165.56 / $187.44	Professional	TC	$104.92	$165.56	$187.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.95 / $159.53 / $386.07	Professional		$89.95	$159.53	$386.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.95 / $37.97 / $69.59	Professional	26	$24.95	$37.97	$69.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.68 / $133.09 / $376.21	Professional	TC	$66.68	$133.09	$376.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.73 / $245.27 / $333.63	Professional		$173.73	$245.27	$333.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.29 / $40.56 / $58.79	Professional	26	$32.29	$40.56	$58.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $129.05 / $206.47 / $272.08	Professional	TC	$129.05	$206.47	$272.08
United Facility/Professional Professional Modifier Low / Median / High Price $97.23 / $152.79 / $273.02	Professional		$97.23	$152.79	$273.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.33 / $35.97 / $60.91	Professional	26	$26.33	$35.97	$60.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.56 / $122.69 / $232.98	Professional	TC	$76.56	$122.69	$232.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $100.35 / $168.80 / $208.82	Professional		$100.35	$168.80	$208.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $22.11 / $37.18 / $47.14	Professional	26	$22.11	$37.18	$47.14
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $78.23 / $131.62 / $164.40	Professional	TC	$78.23	$131.62	$164.40