Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $48.98 / $56.23	Facility	26	$40.74	$48.98	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $162.18 / $724.44	Professional		$48.98	$162.18	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $85.11 / $204.17	Professional	26	$45.71	$85.11	$204.17
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $43.65 / $199.53 / $630.96	Professional	50	$43.65	$199.53	$630.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $173.78 / $630.96	Professional	TC	$102.33	$173.78	$630.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $208.93 / $263.03	Professional		$151.36	$208.93	$263.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $61.66 / $70.79	Professional	26	$52.48	$61.66	$70.79
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $169.82 / $194.98	Professional	TC	$151.36	$169.82	$194.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $75.86 / $75.86	Facility	26	$75.86	$75.86	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $245.47 / $446.68	Professional		$141.25	$245.47	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $57.54 / $104.71	Professional	26	$36.31	$57.54	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $186.21 / $346.74	Professional	TC	$104.71	$186.21	$346.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $194.98 / $288.40	Professional		$165.96	$194.98	$288.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $53.70 / $72.44	Professional	26	$46.77	$53.70	$72.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $141.25 / $229.09	Professional	TC	$120.23	$141.25	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $218.78 / $363.08	Professional		$138.04	$218.78	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $51.29 / $91.20	Professional	26	$30.90	$51.29	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $158.49 / $281.84	Professional	TC	$104.71	$158.49	$281.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $186.21 / $245.47	Professional		$158.49	$186.21	$245.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $54.95 / $70.79	Professional	26	$46.77	$54.95	$70.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $131.83 / $177.83	Professional	TC	$112.20	$131.83	$177.83