Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $36.31 / $40.74	Facility	26	$30.20	$36.31	$40.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $120.23 / $371.54	Professional		$67.61	$120.23	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $61.66 / $181.97	Professional	26	$30.20	$61.66	$181.97
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $64.57 / $281.84 / $776.25	Professional	50	$64.57	$281.84	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $75.86 / $165.96	Professional	TC	$56.23	$75.86	$165.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $97.72 / $125.89	Professional		$33.11	$97.72	$125.89
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $39.81 / $50.12	Professional	26	$30.90	$39.81	$50.12
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $77.62 / $89.13	Professional	TC	$66.07	$77.62	$89.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $56.23 / $56.23	Facility	26	$56.23	$56.23	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $120.23 / $223.87	Professional		$81.28	$120.23	$223.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $40.74 / $75.86	Professional	26	$26.92	$40.74	$75.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $81.28 / $154.88	Professional	TC	$53.70	$81.28	$154.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $123.03 / $177.83	Professional		$107.15	$123.03	$177.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $40.74 / $57.54	Professional	26	$34.67	$40.74	$57.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $81.28 / $123.03	Professional	TC	$70.79	$81.28	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $109.65 / $199.53	Professional		$89.13	$109.65	$199.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $37.15 / $67.61	Professional	26	$28.84	$37.15	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $74.13 / $134.90	Professional	TC	$58.88	$74.13	$134.90
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $131.83 / $154.88	Professional		$93.33	$131.83	$154.88
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $42.66 / $51.29	Professional	26	$30.90	$42.66	$51.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $89.13 / $104.71	Professional	TC	$61.66	$89.13	$104.71