Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $27.54 / $27.54	Facility	26	$27.54	$27.54	$27.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $89.13 / $275.42	Professional		$64.57	$89.13	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $33.11 / $125.89	Professional	26	$25.70	$33.11	$125.89
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $165.96 / $295.12 / $741.31	Professional	50	$165.96	$295.12	$741.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $47.86 / $125.89	Professional	TC	$34.67	$47.86	$125.89
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $75.86 / $104.71	Professional		$34.67	$75.86	$104.71
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $30.90 / $39.81	Professional	26	$30.90	$30.90	$39.81
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $48.98 / $54.95	Professional	TC	$43.65	$48.98	$54.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Facility	26	$51.29	$51.29	$51.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $102.33 / $181.97	Professional		$60.26	$102.33	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $38.90 / $72.44	Professional	26	$24.55	$38.90	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $61.66 / $117.49	Professional	TC	$34.67	$61.66	$117.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $93.33 / $158.49	Professional		$81.28	$93.33	$158.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $38.90 / $56.23	Professional	26	$33.88	$38.90	$56.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $56.23 / $102.33	Professional	TC	$47.86	$56.23	$102.33
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $97.72 / $181.97	Professional		$70.79	$97.72	$181.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $35.48 / $63.10	Professional	26	$26.30	$35.48	$63.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $63.10 / $112.20	Professional	TC	$45.71	$63.10	$112.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $100.00 / $117.49	Professional		$75.86	$100.00	$117.49
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $40.74 / $48.98	Professional	26	$31.62	$40.74	$48.98
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $60.26 / $70.79	Professional	TC	$43.65	$60.26	$70.79