Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.46 / $38.46 / $38.46	Facility	26	$38.46	$38.46	$38.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.55 / $147.04 / $147.04	Professional		$106.55	$147.04	$147.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.46 / $53.07 / $53.07	Professional	26	$38.46	$53.07	$53.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.09 / $93.96 / $93.96	Professional	TC	$68.09	$93.96	$93.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $130.74 / $141.51 / $171.78	Professional		$130.74	$141.51	$171.78
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.81 / $45.34 / $59.58	Professional	26	$40.81	$45.34	$59.58
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $85.39 / $93.08 / $112.20	Professional	TC	$85.39	$93.08	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.20 / $289.39 / $513.26	Professional		$194.20	$289.39	$513.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.09 / $89.66 / $144.57	Professional	26	$72.09	$89.66	$144.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.11 / $181.97 / $414.02	Professional	TC	$122.11	$181.97	$414.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.61 / $159.46 / $250.18	Professional		$123.61	$159.46	$250.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.25 / $55.99 / $87.88	Professional	26	$44.25	$55.99	$87.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $77.48 / $99.96 / $178.29	Professional	TC	$77.48	$99.96	$178.29
United Facility/Professional Professional Modifier Low / Median / High Price $85.63 / $149.41 / $274.41	Professional		$85.63	$149.41	$274.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.05 / $43.33 / $78.56	Professional	26	$20.05	$43.33	$78.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.85 / $90.31 / $203.25	Professional	TC	$55.85	$90.31	$203.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $116.82 / $140.96 / $174.56	Professional		$116.82	$140.96	$174.56
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $43.60 / $53.05 / $63.30	Professional	26	$43.60	$53.05	$63.30
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $73.23 / $87.53 / $111.27	Professional	TC	$73.23	$87.53	$111.27