Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $133.13 / $247.28 / $576.47	Facility		$133.13	$247.28	$576.47
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.23 / $12.56 / $18.36	Facility	26	$9.23	$12.56	$18.36
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $43.76 / $235.12 / $468.08	Facility	TC	$43.76	$235.12	$468.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.21 / $49.60 / $166.00	Professional		$12.21	$49.60	$166.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.23 / $12.41 / $48.00	Professional	26	$9.23	$12.41	$48.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $41.00 / $52.28 / $52.28	Professional	50	$41.00	$52.28	$52.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.56 / $35.88 / $132.80	Professional	TC	$27.56	$35.88	$132.80
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $45.50 / $47.30 / $61.49	Professional		$45.50	$47.30	$61.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $11.37 / $12.63 / $16.04	Professional	26	$11.37	$12.63	$16.04
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $32.86 / $34.67 / $45.07	Professional	TC	$32.86	$34.67	$45.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.36 / $52.87 / $107.18	Professional		$35.36	$52.87	$107.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.35 / $12.81 / $24.98	Professional	26	$8.35	$12.81	$24.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.73 / $39.54 / $82.63	Professional	TC	$27.73	$39.54	$82.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $49.29 / $59.52 / $81.94	Professional		$49.29	$59.52	$81.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.69 / $12.51 / $17.76	Professional	26	$10.69	$12.51	$17.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.51 / $46.54 / $64.16	Professional	TC	$38.51	$46.54	$64.16
United Facility/Professional Professional Modifier Low / Median / High Price $34.46 / $45.83 / $83.78	Professional		$34.46	$45.83	$83.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.68 / $11.55 / $19.73	Professional	26	$8.68	$11.55	$19.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.78 / $34.22 / $61.01	Professional	TC	$25.78	$34.22	$61.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $35.83 / $54.16 / $70.41	Professional		$35.83	$54.16	$70.41
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $7.81 / $11.52 / $15.71	Professional	26	$7.81	$11.52	$15.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.02 / $42.79 / $54.71	Professional	TC	$28.02	$42.79	$54.71