Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.49 / $159.75 / $306.24	Facility		$41.49	$159.75	$306.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.95 / $8.40 / $13.83	Facility	26	$6.95	$8.40	$13.83
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.22 / $132.00 / $352.08	Facility	TC	$28.22	$132.00	$352.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.96 / $36.34 / $143.00	Professional		$20.96	$36.34	$143.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.00 / $9.15 / $38.64	Professional	26	$7.00	$9.15	$38.64
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $69.64 / $75.59 / $154.75	Professional	50	$69.64	$75.59	$154.75
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.46 / $16.45 / $94.43	Professional	52	$14.46	$16.45	$94.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $25.30 / $62.52	Professional	TC	$20.07	$25.30	$62.52
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.49 / $36.50 / $41.72	Professional		$30.49	$36.50	$41.72
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $10.13 / $11.58	Professional	26	$9.11	$10.13	$11.58
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $21.25 / $26.37 / $30.14	Professional	TC	$21.25	$26.37	$30.14
Cigna Facility/Professional Facility Modifier Low / Median / High Price $33.86 / $33.86 / $33.86	Facility		$33.86	$33.86	$33.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.32 / $36.51 / $76.47	Professional		$26.32	$36.51	$76.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.30 / $9.81 / $18.44	Professional	26	$6.30	$9.81	$18.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $27.01 / $58.11	Professional	TC	$19.89	$27.01	$58.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $33.61 / $41.29 / $59.66	Professional		$33.61	$41.29	$59.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $9.77 / $14.69	Professional	26	$8.11	$9.77	$14.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.23 / $31.16 / $46.29	Professional	TC	$25.23	$31.16	$46.29
United Facility/Professional Professional Modifier Low / Median / High Price $22.85 / $33.20 / $56.15	Professional		$22.85	$33.20	$56.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.27 / $8.24 / $14.72	Professional	26	$6.27	$8.24	$14.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.73 / $24.54 / $41.91	Professional	TC	$16.73	$24.54	$41.91
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $23.14 / $38.22 / $49.71	Professional		$23.14	$38.22	$49.71
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $5.37 / $8.64 / $11.77	Professional	26	$5.37	$8.64	$11.77
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $17.76 / $29.68 / $37.94	Professional	TC	$17.76	$29.68	$37.94