Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $95.50 / $575.44	Facility		$53.70	$95.50	$575.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $21.38 / $53.70	Facility	26	$7.08	$21.38	$53.70
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.18 / $81.28 / $199.53	Facility	TC	$28.18	$81.28	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $34.67 / $93.33	Professional		$8.71	$34.67	$93.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $16.98 / $46.77	Professional	26	$7.08	$16.98	$46.77
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $128.82 / $316.23	Professional	50	$42.66	$128.82	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $38.02 / $81.28	Professional	TC	$20.89	$38.02	$81.28
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $41.69 / $120.23	Professional		$28.84	$41.69	$120.23
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $8.91 / $15.85	Professional	26	$7.94	$8.91	$15.85
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $32.36 / $41.69	Professional	TC	$27.54	$32.36	$41.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $218.78 / $234.42	Facility		$131.83	$218.78	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $37.15 / $107.15	Professional		$29.51	$37.15	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.00 / $22.39	Professional	26	$7.08	$10.00	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $28.18 / $72.44	Professional	TC	$20.89	$28.18	$72.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $46.77 / $87.10	Professional		$39.81	$46.77	$87.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $10.00 / $18.62	Professional	26	$8.71	$10.00	$18.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $37.15 / $69.18	Professional	TC	$30.90	$37.15	$69.18
United Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $416.87 / $489.78	Facility		$363.08	$416.87	$489.78
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $42.66 / $109.65	Professional		$25.70	$42.66	$109.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $10.47 / $23.44	Professional	26	$6.61	$10.47	$23.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $32.36 / $87.10	Professional	TC	$19.50	$32.36	$87.10