Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $59.50 / $82.73 / $225.00	Professional		$59.50	$82.73	$225.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $113.88 / $113.88 / $113.88	Professional	25	$113.88	$113.88	$113.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.25 / $38.88 / $123.42	Professional	26	$33.25	$38.88	$123.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.05 / $40.93 / $71.55	Professional	TC	$21.05	$40.93	$71.55
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $82.95 / $92.17 / $159.44	Professional		$82.95	$92.17	$159.44
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $46.98 / $46.98 / $81.28	Professional	26	$46.98	$46.98	$81.28
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $40.67 / $45.18 / $63.70	Professional	TC	$40.67	$45.18	$63.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.48 / $91.53 / $233.37	Professional		$64.48	$91.53	$233.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.04 / $50.44 / $110.50	Professional	26	$35.04	$50.44	$110.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.76 / $40.69 / $121.11	Professional	TC	$23.76	$40.69	$121.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.30 / $91.32 / $134.38	Professional		$72.30	$91.32	$134.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.52 / $41.81 / $63.13	Professional	26	$32.52	$41.81	$63.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.70 / $48.89 / $71.70	Professional	TC	$38.70	$48.89	$71.70
United Facility/Professional Professional Modifier Low / Median / High Price $56.13 / $75.31 / $117.92	Professional		$56.13	$75.31	$117.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.50 / $41.93 / $66.43	Professional	26	$31.50	$41.93	$66.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.60 / $31.59 / $56.13	Professional	TC	$20.60	$31.59	$56.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $50.17 / $64.04 / $114.15	Professional		$50.17	$64.04	$114.15
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $22.89 / $29.81 / $53.05	Professional	26	$22.89	$29.81	$53.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $27.27 / $34.22 / $61.11	Professional	TC	$27.27	$34.22	$61.11