Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.87 / $27.44 / $30.62	Facility	26	$22.87	$27.44	$30.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.71 / $103.01 / $274.76	Professional		$86.71	$103.01	$274.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.87 / $26.10 / $72.38	Professional	26	$22.87	$26.10	$72.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.08 / $78.43 / $201.37	Professional	TC	$63.08	$78.43	$201.37
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $91.06 / $110.67 / $126.49	Professional		$91.06	$110.67	$126.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $25.36 / $28.18 / $32.21	Professional	26	$25.36	$28.18	$32.21
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $62.40 / $82.49 / $94.28	Professional	TC	$62.40	$82.49	$94.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.59 / $109.18 / $220.76	Professional		$79.59	$109.18	$220.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.37 / $30.41 / $57.94	Professional	26	$20.37	$30.41	$57.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.53 / $81.80 / $172.73	Professional	TC	$58.53	$81.80	$172.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.90 / $121.13 / $173.39	Professional		$102.90	$121.13	$173.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.99 / $30.77 / $43.84	Professional	26	$25.99	$30.77	$43.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $76.51 / $91.17 / $129.54	Professional	TC	$76.51	$91.17	$129.54
United Facility/Professional Professional Modifier Low / Median / High Price $70.08 / $94.23 / $175.96	Professional		$70.08	$94.23	$175.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.55 / $28.51 / $48.24	Professional	26	$19.55	$28.51	$48.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.72 / $74.76 / $126.16	Professional	TC	$55.72	$74.76	$126.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $74.70 / $112.07 / $146.19	Professional		$74.70	$112.07	$146.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $19.16 / $28.07 / $38.28	Professional	26	$19.16	$28.07	$38.28
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $55.55 / $84.42 / $107.91	Professional	TC	$55.55	$84.42	$107.91