Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.28 / $54.98 / $80.17	Facility	26	$40.28	$54.98	$80.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.56 / $211.03 / $693.32	Professional		$68.56	$211.03	$693.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $55.00 / $213.54	Professional	26	$41.81	$55.00	$213.54
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $605.36 / $605.36 / $636.40	Professional	50	$605.36	$605.36	$636.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.99 / $177.61 / $548.62	Professional	TC	$96.99	$177.61	$548.62
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $207.64 / $224.70 / $285.37	Professional		$207.64	$224.70	$285.37
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.33 / $52.67 / $66.89	Professional	26	$52.33	$52.67	$66.89
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $154.83 / $172.03 / $218.48	Professional	TC	$154.83	$172.03	$218.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.19 / $265.32 / $451.51	Professional		$144.19	$265.32	$451.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $59.74 / $109.51	Professional	26	$36.54	$59.74	$109.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $105.94 / $194.45 / $326.95	Professional	TC	$105.94	$194.45	$326.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.08 / $218.11 / $368.26	Professional		$169.08	$218.11	$368.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.61 / $56.69 / $91.71	Professional	26	$46.61	$56.69	$91.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $121.84 / $157.16 / $269.10	Professional	TC	$121.84	$157.16	$269.10
United Facility/Professional Professional Modifier Low / Median / High Price $137.84 / $196.74 / $350.80	Professional		$137.84	$196.74	$350.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.89 / $51.03 / $86.63	Professional	26	$25.89	$51.03	$86.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $92.78 / $156.34 / $285.19	Professional	TC	$92.78	$156.34	$285.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $129.69 / $176.42 / $229.35	Professional		$129.69	$176.42	$229.35
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $49.58 / $64.45	Professional	26	$37.79	$49.58	$64.45
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $91.90 / $126.84 / $162.13	Professional	TC	$91.90	$126.84	$162.13