Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $61.66 / $165.96	Professional		$52.48	$61.66	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $20.89 / $77.62	Professional	26	$19.05	$20.89	$77.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $41.69 / $95.50	Professional	TC	$30.90	$41.69	$95.50
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $64.57 / $83.18	Professional		$28.84	$64.57	$83.18
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $20.89 / $25.70	Professional	26	$19.05	$20.89	$25.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $48.98 / $63.10	Professional	TC	$42.66	$48.98	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $0.95 / $42.66 / $104.71	Professional		$0.95	$42.66	$104.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $0.28 / $13.49 / $40.74	Professional	26	$0.28	$13.49	$40.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $0.69 / $29.51 / $91.20	Professional	TC	$0.69	$29.51	$91.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $100.00 / $131.83	Professional		$87.10	$100.00	$131.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $30.20 / $42.66	Professional	26	$25.12	$30.20	$42.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $72.44 / $95.50	Professional	TC	$63.10	$72.44	$95.50
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $56.23 / $117.49	Professional		$38.02	$56.23	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $20.89 / $42.66	Professional	26	$16.22	$20.89	$42.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $34.67 / $67.61	Professional	TC	$21.38	$34.67	$67.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $123.03 / $138.04	Professional		$57.54	$123.03	$138.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $33.88 / $38.02	Professional	26	$21.88	$33.88	$38.02
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $87.10 / $100.00	Professional	TC	$35.48	$87.10	$100.00