Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.07 / $10.07 / $10.07	Facility	26	$10.07	$10.07	$10.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.52 / $94.71 / $275.00	Professional		$86.52	$94.71	$275.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.07 / $11.77 / $55.00	Professional	26	$10.07	$11.77	$55.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.64 / $84.26 / $220.00	Professional	TC	$74.64	$84.26	$220.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $122.51 / $122.51 / $146.22	Professional		$122.51	$122.51	$146.22
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.98 / $12.98 / $15.31	Professional	26	$12.98	$12.98	$15.31
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $109.53 / $109.53 / $130.93	Professional	TC	$109.53	$109.53	$130.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.40 / $167.19 / $283.70	Professional		$91.40	$167.19	$283.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $13.70 / $26.47	Professional	26	$9.11	$13.70	$26.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.83 / $149.22 / $252.61	Professional	TC	$81.83	$149.22	$252.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.38 / $123.72 / $202.55	Professional		$97.38	$123.72	$202.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.66 / $14.00 / $19.35	Professional	26	$11.66	$14.00	$19.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.86 / $110.34 / $183.20	Professional	TC	$83.86	$110.34	$183.20
United Facility/Professional Professional Modifier Low / Median / High Price $74.72 / $133.63 / $225.13	Professional		$74.72	$133.63	$225.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.20 / $13.28 / $26.14	Professional	26	$6.20	$13.28	$26.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.81 / $113.94 / $209.98	Professional	TC	$66.81	$113.94	$209.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $65.61 / $114.56 / $147.80	Professional		$65.61	$114.56	$147.80
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $7.43 / $12.40 / $16.12	Professional	26	$7.43	$12.40	$16.12
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $58.18 / $102.17 / $130.62	Professional	TC	$58.18	$102.17	$130.62