Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $150.26 / $403.20 / $646.79	Facility		$150.26	$403.20	$646.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.01 / $38.07 / $55.73	Facility	26	$28.01	$38.07	$55.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.08 / $94.71 / $401.00	Professional		$75.08	$94.71	$401.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.03 / $49.98 / $144.00	Professional	26	$29.03	$49.98	$144.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $105.64 / $292.91 / $641.46	Professional	50	$105.64	$292.91	$641.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.41 / $54.81 / $238.00	Professional	TC	$47.41	$54.81	$238.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $82.05 / $91.17 / $182.34	Professional		$82.05	$91.17	$182.34
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $33.56 / $37.29 / $68.63	Professional	26	$33.56	$37.29	$68.63
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $48.49 / $53.88 / $87.48	Professional	TC	$48.49	$53.88	$87.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.30 / $99.95 / $189.00	Professional		$67.30	$99.95	$189.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.08 / $38.65 / $71.29	Professional	26	$25.08	$38.65	$71.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.94 / $65.23 / $118.30	Professional	TC	$41.94	$65.23	$118.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.67 / $105.20 / $152.47	Professional		$87.67	$105.20	$152.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.68 / $39.42 / $53.77	Professional	26	$32.68	$39.42	$53.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.82 / $66.58 / $98.70	Professional	TC	$54.82	$66.58	$98.70
United Facility/Professional Professional Modifier Low / Median / High Price $73.29 / $89.20 / $162.16	Professional		$73.29	$89.20	$162.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.48 / $33.33 / $59.92	Professional	26	$26.48	$33.33	$59.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.17 / $58.72 / $137.47	Professional	TC	$46.17	$58.72	$137.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $76.06 / $100.82 / $124.98	Professional		$76.06	$100.82	$124.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.50 / $37.78 / $47.60	Professional	26	$28.50	$37.78	$47.60
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $47.57 / $63.04 / $78.69	Professional	TC	$47.57	$63.04	$78.69