Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.01 / $36.01 / $40.83	Facility	26	$30.01	$36.01	$40.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.92 / $110.31 / $441.00	Professional		$89.92	$110.31	$441.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.01 / $34.14 / $83.39	Professional	26	$30.01	$34.14	$83.39
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $113.77 / $357.05 / $749.61	Professional	50	$113.77	$357.05	$749.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.11 / $70.84 / $165.67	Professional	TC	$61.11	$70.84	$165.67
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $100.06 / $111.18 / $184.62	Professional		$100.06	$111.18	$184.62
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $36.03 / $40.03 / $68.63	Professional	26	$36.03	$40.03	$68.63
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $64.04 / $71.15 / $103.88	Professional	TC	$64.04	$71.15	$103.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.76 / $124.06 / $238.18	Professional		$81.76	$124.06	$238.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.89 / $41.45 / $76.42	Professional	26	$26.89	$41.45	$76.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.06 / $84.26 / $153.94	Professional	TC	$54.06	$84.26	$153.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $105.70 / $126.84 / $185.93	Professional		$105.70	$126.84	$185.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.04 / $42.23 / $57.34	Professional	26	$35.04	$42.23	$57.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.51 / $85.67 / $128.93	Professional	TC	$70.51	$85.67	$128.93
United Facility/Professional Professional Modifier Low / Median / High Price $87.19 / $109.96 / $259.80	Professional		$87.19	$109.96	$259.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.30 / $36.43 / $66.22	Professional	26	$28.30	$36.43	$66.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.28 / $75.12 / $133.47	Professional	TC	$60.28	$75.12	$133.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $92.82 / $121.55 / $150.60	Professional		$92.82	$121.55	$150.60
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $40.47 / $51.05	Professional	26	$30.90	$40.47	$51.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $61.92 / $81.09 / $101.24	Professional	TC	$61.92	$81.09	$101.24