Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.45 / $136.57 / $199.07	Facility		$41.45	$136.57	$199.07
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.95 / $9.41 / $13.83	Facility	26	$6.95	$9.41	$13.83
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $20.95 / $89.25 / $360.40	Facility	TC	$20.95	$89.25	$360.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.26 / $31.48 / $174.26	Professional		$20.26	$31.48	$174.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.00 / $8.65 / $46.55	Professional	26	$7.00	$8.65	$46.55
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.18 / $71.19 / $143.54	Professional	50	$38.18	$71.19	$143.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.29 / $15.13 / $169.66	Professional	52	$13.29	$15.13	$169.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $23.04 / $56.85	Professional	TC	$17.89	$23.04	$56.85
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.16 / $32.58 / $37.24	Professional		$30.16	$32.58	$37.24
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $8.06 / $8.94 / $10.24	Professional	26	$8.06	$8.94	$10.24
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $21.25 / $23.62 / $27.00	Professional	TC	$21.25	$23.62	$27.00
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 $24.54 / $33.19 / $71.29	Professional		$24.54	$33.19	$71.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.29 / $9.38 / $17.71	Professional	26	$6.29	$9.38	$17.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.32 / $24.22 / $52.91	Professional	TC	$17.32	$24.22	$52.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $38.36 / $54.73	Professional		$30.20	$38.36	$54.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $9.36 / $14.12	Professional	26	$8.11	$9.36	$14.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.93 / $29.14 / $41.36	Professional	TC	$22.93	$29.14	$41.36
United Facility/Professional Professional Modifier Low / Median / High Price $21.54 / $29.67 / $51.86	Professional		$21.54	$29.67	$51.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $8.66 / $14.72	Professional	26	$6.03	$8.66	$14.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.59 / $22.44 / $41.25	Professional	TC	$15.59	$22.44	$41.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $21.17 / $35.53 / $46.26	Professional		$21.17	$35.53	$46.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $5.28 / $8.64 / $11.77	Professional	26	$5.28	$8.64	$11.77
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $15.88 / $26.98 / $34.49	Professional	TC	$15.88	$26.98	$34.49