Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $281.84 / $281.84	Facility		$281.84	$281.84	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $75.86 / $199.53	Professional		$50.12	$75.86	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $46.77 / $151.36	Professional	26	$18.20	$46.77	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $48.98 / $117.49	Professional	TC	$30.90	$48.98	$117.49
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $53.70 / $79.43	Professional		$20.89	$53.70	$79.43
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $26.92 / $74.13	Professional	26	$17.78	$26.92	$74.13
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $42.66 / $74.13	Professional	TC	$39.81	$42.66	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $0.79 / $38.90 / $89.13	Professional		$0.79	$38.90	$89.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $0.25 / $12.88 / $37.15	Professional	26	$0.25	$12.88	$37.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $0.56 / $25.12 / $79.43	Professional	TC	$0.56	$25.12	$79.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $83.18 / $114.82	Professional		$72.44	$83.18	$114.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $26.30 / $47.86	Professional	26	$21.88	$26.30	$47.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $61.66 / $77.62	Professional	TC	$51.29	$61.66	$77.62
United Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $56.23 / $114.82	Professional		$44.67	$56.23	$114.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $19.95 / $38.02	Professional	26	$15.49	$19.95	$38.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $38.02 / $70.79	Professional	TC	$28.18	$38.02	$70.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $102.33 / $114.82	Professional		$57.54	$102.33	$114.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $30.20 / $33.88	Professional	26	$20.89	$30.20	$33.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $72.44 / $81.28	Professional	TC	$36.31	$72.44	$81.28