Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.15 / $34.15 / $46.80	Facility	26	$34.15	$34.15	$46.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.52 / $121.94 / $199.24	Professional		$52.52	$121.94	$199.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.15 / $36.49 / $58.96	Professional	26	$34.15	$36.49	$58.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.03 / $87.78 / $140.28	Professional	TC	$16.03	$87.78	$140.28
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $116.79 / $171.17 / $217.39	Professional		$116.79	$171.17	$217.39
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $44.97 / $44.97 / $57.11	Professional	26	$44.97	$44.97	$57.11
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $72.90 / $126.20 / $155.88	Professional	TC	$72.90	$126.20	$155.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.25 / $124.13 / $374.33	Professional		$81.25	$124.13	$374.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.45 / $46.88 / $105.81	Professional	26	$31.45	$46.88	$105.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.60 / $86.15 / $267.44	Professional	TC	$17.60	$86.15	$267.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $100.85 / $183.45 / $233.25	Professional		$100.85	$183.45	$233.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.65 / $52.45 / $77.47	Professional	26	$40.65	$52.45	$77.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.92 / $123.41 / $169.01	Professional	TC	$72.92	$123.41	$169.01
United Facility/Professional Professional Modifier Low / Median / High Price $62.09 / $116.55 / $241.54	Professional		$62.09	$116.55	$241.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.58 / $43.01 / $124.01	Professional	26	$30.58	$43.01	$124.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.59 / $80.26 / $146.25	Professional	TC	$19.59	$80.26	$146.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $76.81 / $161.90 / $201.71	Professional		$76.81	$161.90	$201.71
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $21.96 / $46.76 / $55.86	Professional	26	$21.96	$46.76	$55.86
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $54.85 / $114.74 / $145.85	Professional	TC	$54.85	$114.74	$145.85