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 $54.62 / $181.87 / $693.31	Professional		$54.62	$181.87	$693.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $53.49 / $177.29	Professional	26	$41.81	$53.49	$177.29
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $605.36 / $636.40 / $657.10	Professional	50	$605.36	$636.40	$657.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.56 / $148.08 / $313.39	Professional	TC	$78.56	$148.08	$313.39
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $184.06 / $225.43 / $286.30	Professional		$184.06	$225.43	$286.30
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 $122.83 / $172.76 / $219.41	Professional	TC	$122.83	$172.76	$219.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.03 / $240.22 / $388.62	Professional		$115.03	$240.22	$388.62
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 $83.57 / $170.72 / $280.50	Professional	TC	$83.57	$170.72	$280.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $136.22 / $175.74 / $295.77	Professional		$136.22	$175.74	$295.77
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 $88.99 / $114.80 / $219.74	Professional	TC	$88.99	$114.80	$219.74
United Facility/Professional Professional Modifier Low / Median / High Price $118.31 / $180.95 / $350.19	Professional		$118.31	$180.95	$350.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.89 / $51.25 / $95.01	Professional	26	$25.89	$51.25	$95.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $129.61 / $307.61	Professional	TC	$90.19	$129.61	$307.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $108.98 / $147.88 / $192.26	Professional		$108.98	$147.88	$192.26
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 $71.19 / $98.31 / $125.69	Professional	TC	$71.19	$98.31	$125.69