Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.94 / $38.00 / $51.62	Facility	26	$25.94	$38.00	$51.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.29 / $109.95 / $294.66	Professional		$86.29	$109.95	$294.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.53 / $27.74 / $80.75	Professional	26	$17.53	$27.74	$80.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.30 / $84.01 / $225.14	Professional	TC	$49.30	$84.01	$225.14
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $119.60 / $136.13 / $155.19	Professional		$119.60	$136.13	$155.19
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $37.96 / $43.27	Professional	26	$32.11	$37.96	$43.27
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $88.36 / $98.18 / $111.93	Professional	TC	$88.36	$98.18	$111.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1.52 / $73.39 / $185.92	Professional		$1.52	$73.39	$185.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $0.38 / $18.39 / $47.78	Professional	26	$0.38	$18.39	$47.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1.13 / $55.00 / $138.19	Professional	TC	$1.13	$55.00	$138.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $133.78 / $167.23 / $249.02	Professional		$133.78	$167.23	$249.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.93 / $41.16 / $56.29	Professional	26	$32.93	$41.16	$56.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.85 / $126.06 / $193.68	Professional	TC	$100.85	$126.06	$193.68
United Facility/Professional Professional Modifier Low / Median / High Price $68.94 / $108.62 / $278.49	Professional		$68.94	$108.62	$278.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.03 / $25.83 / $46.92	Professional	26	$18.03	$25.83	$46.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $51.62 / $82.79 / $131.72	Professional	TC	$51.62	$82.79	$131.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $116.06 / $153.85 / $190.61	Professional		$116.06	$153.85	$190.61
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.36 / $37.86 / $48.15	Professional	26	$30.36	$37.86	$48.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $85.71 / $115.98 / $144.85	Professional	TC	$85.71	$115.98	$144.85