Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.37 / $27.37 / $27.37	Facility	26	$27.37	$27.37	$27.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.92 / $79.73 / $254.51	Professional		$65.92	$79.73	$254.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.21 / $31.00 / $90.34	Professional	26	$27.21	$31.00	$90.34
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $203.05 / $359.52 / $973.29	Professional	50	$203.05	$359.52	$973.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.54 / $49.35 / $119.79	Professional	TC	$38.54	$49.35	$119.79
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $89.96 / $99.95 / $145.63	Professional		$89.96	$99.95	$145.63
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $34.40 / $38.22 / $43.25	Professional	26	$34.40	$38.22	$43.25
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $55.56 / $61.73 / $107.71	Professional	TC	$55.56	$61.73	$107.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.80 / $100.93 / $183.46	Professional		$59.80	$100.93	$183.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.76 / $39.18 / $74.30	Professional	26	$24.76	$39.18	$74.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.04 / $61.28 / $119.52	Professional	TC	$35.04	$61.28	$119.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $76.78 / $97.51 / $174.29	Professional		$76.78	$97.51	$174.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.42 / $39.54 / $58.88	Professional	26	$32.42	$39.54	$58.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.36 / $57.22 / $111.94	Professional	TC	$44.36	$57.22	$111.94
United Facility/Professional Professional Modifier Low / Median / High Price $68.98 / $96.54 / $185.49	Professional		$68.98	$96.54	$185.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.20 / $36.81 / $68.94	Professional	26	$26.20	$36.81	$68.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.35 / $63.12 / $112.33	Professional	TC	$43.35	$63.12	$112.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $75.48 / $88.30 / $109.77	Professional		$75.48	$88.30	$109.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.87 / $37.28 / $47.19	Professional	26	$31.87	$37.28	$47.19
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $43.62 / $51.01 / $63.65	Professional	TC	$43.62	$51.01	$63.65