Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $446.68 / $691.83	Facility		$251.19	$446.68	$691.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $33.88 / $56.23	Facility	26	$28.18	$33.88	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $100.00 / $407.38	Professional		$53.70	$100.00	$407.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $67.61 / $158.49	Professional	26	$30.20	$67.61	$158.49
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $66.07 / $181.97 / $645.65	Professional	50	$66.07	$181.97	$645.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $64.57 / $257.04	Professional	TC	$43.65	$64.57	$257.04
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $85.11 / $109.65	Professional		$60.26	$85.11	$109.65
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $34.67 / $39.81	Professional	26	$30.90	$34.67	$39.81
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $54.95 / $81.28	Professional	TC	$51.29	$54.95	$81.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $131.83 / $131.83	Facility		$131.83	$131.83	$131.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	26	$52.48	$52.48	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $100.00 / $186.21	Professional		$67.61	$100.00	$186.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $38.02 / $70.79	Professional	26	$25.12	$38.02	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $63.10 / $117.49	Professional	TC	$41.69	$63.10	$117.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $102.33 / $147.91	Professional		$89.13	$102.33	$147.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $37.15 / $53.70	Professional	26	$32.36	$37.15	$53.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $64.57 / $93.33	Professional	TC	$56.23	$64.57	$93.33
United Facility/Professional Facility Modifier Low / Median / High Price $26.92 / $51.29 / $91.20	Facility		$26.92	$51.29	$91.20
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $89.13 / $165.96	Professional		$72.44	$89.13	$165.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $34.67 / $63.10	Professional	26	$26.92	$34.67	$63.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $57.54 / $102.33	Professional	TC	$44.67	$57.54	$102.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $109.65 / $128.82	Professional		$75.86	$109.65	$128.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $38.90 / $47.86	Professional	26	$28.18	$38.90	$47.86
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $70.79 / $83.18	Professional	TC	$47.86	$70.79	$83.18