Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $144.54 / $645.65	Facility		$77.62	$144.54	$645.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $12.02 / $52.48	Facility	26	$8.91	$12.02	$52.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.18 / $114.82 / $354.81	Facility	TC	$28.18	$114.82	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $48.98 / $138.04	Professional		$28.84	$48.98	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $14.13 / $43.65	Professional	26	$9.33	$14.13	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $33.11 / $79.43	Professional	TC	$19.05	$33.11	$79.43
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $33.88 / $38.90	Professional		$9.77	$33.88	$38.90
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $10.96 / $12.59	Professional	26	$9.77	$10.96	$12.59
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $24.55 / $30.90	Professional	TC	$22.91	$24.55	$30.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $23.44 / $52.48	Facility		$23.44	$23.44	$52.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $16.98 / $16.98	Facility	26	$16.98	$16.98	$16.98
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $36.31 / $36.31 / $36.31	Facility	TC	$36.31	$36.31	$36.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $35.48 / $67.61	Professional		$25.70	$35.48	$67.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $12.02 / $23.99	Professional	26	$8.13	$12.02	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $23.99 / $51.29	Professional	TC	$16.98	$23.99	$51.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $38.90 / $52.48	Professional		$34.67	$38.90	$52.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $11.48 / $15.49	Professional	26	$10.23	$11.48	$15.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $27.54 / $37.15	Professional	TC	$24.55	$27.54	$37.15
United Facility/Professional Facility Modifier Low / Median / High Price $8.13 / $17.38 / $30.90	Facility		$8.13	$17.38	$30.90
United Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $33.11 / $60.26	Professional		$25.12	$33.11	$60.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $11.22 / $19.05	Professional	26	$8.32	$11.22	$19.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $21.88 / $40.74	Professional	TC	$16.98	$21.88	$40.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $40.74 / $54.95	Professional		$26.92	$40.74	$54.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.02 / $15.85	Professional	26	$7.94	$12.02	$15.85
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $28.18 / $38.90	Professional	TC	$18.62	$28.18	$38.90