Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.59 / $24.59 / $24.59	Facility	26	$24.59	$24.59	$24.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.68 / $106.50 / $274.83	Professional		$92.68	$106.50	$274.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.59 / $28.00 / $72.56	Professional	26	$24.59	$28.00	$72.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.25 / $75.04 / $182.48	Professional	TC	$67.25	$75.04	$182.48
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $115.85 / $128.72 / $145.66	Professional		$115.85	$128.72	$145.66
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.23 / $33.59 / $38.01	Professional	26	$30.23	$33.59	$38.01
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $85.62 / $95.13 / $108.74	Professional	TC	$85.62	$95.13	$108.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.22 / $123.02 / $230.99	Professional		$83.22	$123.02	$230.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.93 / $33.61 / $62.53	Professional	26	$21.93	$33.61	$62.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.51 / $92.64 / $170.31	Professional	TC	$60.51	$92.64	$170.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.80 / $131.76 / $188.45	Professional		$109.80	$131.76	$188.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.66 / $34.51 / $46.56	Professional	26	$28.66	$34.51	$46.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.05 / $98.38 / $141.87	Professional	TC	$81.05	$98.38	$141.87
United Facility/Professional Professional Modifier Low / Median / High Price $87.77 / $109.23 / $199.03	Professional		$87.77	$109.23	$199.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.74 / $28.76 / $54.10	Professional	26	$22.74	$28.76	$54.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.69 / $81.30 / $171.31	Professional	TC	$65.69	$81.30	$171.31
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $94.45 / $126.27 / $156.05	Professional		$94.45	$126.27	$156.05
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $24.74 / $33.07 / $41.73	Professional	26	$24.74	$33.07	$41.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $69.72 / $93.21 / $116.27	Professional	TC	$69.72	$93.21	$116.27