Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.16 / $133.85 / $309.24	Facility		$50.16	$133.85	$309.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.34 / $7.68 / $12.63	Facility	26	$6.34	$7.68	$12.63
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $18.86 / $125.15 / $468.08	Facility	TC	$18.86	$125.15	$468.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.23 / $30.77 / $130.94	Professional		$24.23	$30.77	$130.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.42 / $8.07 / $37.00	Professional	26	$6.42	$8.07	$37.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.30 / $72.48 / $148.41	Professional	50	$18.30	$72.48	$148.41
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.12 / $13.65 / $79.83	Professional	52	$12.12	$13.65	$79.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.82 / $20.74 / $50.19	Professional	TC	$17.82	$20.74	$50.19
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $27.50 / $30.55 / $38.79	Professional		$27.50	$30.55	$38.79
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $7.32 / $8.14 / $10.69	Professional	26	$7.32	$8.14	$10.69
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $20.17 / $22.41 / $28.46	Professional	TC	$20.17	$22.41	$28.46
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 $22.57 / $32.53 / $62.20	Professional		$22.57	$32.53	$62.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $8.81 / $17.14	Professional	26	$5.75	$8.81	$17.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.87 / $24.00 / $47.71	Professional	TC	$16.87	$24.00	$47.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $29.49 / $34.61 / $49.79	Professional		$29.49	$34.61	$49.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.39 / $8.94 / $14.12	Professional	26	$7.39	$8.94	$14.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $26.22 / $37.65	Professional	TC	$21.38	$26.22	$37.65
United Facility/Professional Professional Modifier Low / Median / High Price $21.44 / $29.08 / $63.34	Professional		$21.44	$29.08	$63.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.02 / $7.94 / $13.37	Professional	26	$6.02	$7.94	$13.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.97 / $20.21 / $36.02	Professional	TC	$14.97	$20.21	$36.02
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $20.87 / $32.06 / $41.84	Professional		$20.87	$32.06	$41.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $5.27 / $7.92 / $10.80	Professional	26	$5.27	$7.92	$10.80
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $15.60 / $24.28 / $31.04	Professional	TC	$15.60	$24.28	$31.04