Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.26 / $25.26 / $25.26	Facility	26	$25.26	$25.26	$25.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.93 / $125.64 / $350.78	Professional		$109.93	$125.64	$350.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.49 / $22.06 / $75.00	Professional	26	$14.49	$22.06	$75.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.53 / $106.95 / $274.05	Professional	TC	$95.53	$106.95	$274.05
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $122.33 / $127.54 / $186.21	Professional		$122.33	$127.54	$186.21
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $16.30 / $21.51 / $31.40	Professional	26	$16.30	$21.51	$31.40
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $106.03 / $106.03 / $154.80	Professional	TC	$106.03	$106.03	$154.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.85 / $177.91 / $279.73	Professional		$120.85	$177.91	$279.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.80 / $25.97 / $50.78	Professional	26	$15.80	$25.97	$50.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.07 / $157.66 / $245.83	Professional	TC	$97.07	$157.66	$245.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $127.13 / $164.00 / $234.55	Professional		$127.13	$164.00	$234.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.56 / $28.23 / $39.76	Professional	26	$22.56	$28.23	$39.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.06 / $134.24 / $194.79	Professional	TC	$104.06	$134.24	$194.79
United Facility/Professional Professional Modifier Low / Median / High Price $114.50 / $175.36 / $331.98	Professional		$114.50	$175.36	$331.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.68 / $23.04 / $48.22	Professional	26	$12.68	$23.04	$48.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.07 / $140.22 / $274.50	Professional	TC	$93.07	$140.22	$274.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $103.02 / $146.19 / $180.56	Professional		$103.02	$146.19	$180.56
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $18.70 / $26.53 / $33.35	Professional	26	$18.70	$26.53	$33.35
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $84.32 / $119.67 / $149.34	Professional	TC	$84.32	$119.67	$149.34