Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $339.41 / $492.47 / $603.45	Facility		$339.41	$492.47	$603.45
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $581.07 / $581.07 / $595.75	Facility	26	$581.07	$581.07	$595.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.03 / $79.06 / $209.01	Professional		$46.03	$79.06	$209.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.10 / $33.43 / $80.02	Professional	26	$28.10	$33.43	$80.02
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $56.53 / $326.11 / $334.86	Professional	50	$56.53	$326.11	$334.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.39 / $29.82 / $48.65	Professional	52	$23.39	$29.82	$48.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.59 / $51.56 / $117.94	Professional	TC	$18.59	$51.56	$117.94
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $47.37 / $52.63 / $76.84	Professional		$47.37	$52.63	$76.84
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $16.97 / $27.41 / $40.02	Professional	26	$16.97	$27.41	$40.02
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $20.62 / $25.22 / $36.82	Professional	TC	$20.62	$25.22	$36.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.10 / $100.10 / $100.10	Facility		$100.10	$100.10	$100.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.47 / $92.04 / $152.04	Professional		$38.47	$92.04	$152.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.82 / $37.69 / $71.91	Professional	26	$22.82	$37.69	$71.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.00 / $46.39 / $89.64	Professional	TC	$15.00	$46.39	$89.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.30 / $60.38 / $124.36	Professional		$48.30	$60.38	$124.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.10 / $36.11 / $49.66	Professional	26	$30.10	$36.11	$49.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $23.05 / $58.46	Professional	TC	$18.21	$23.05	$58.46
United Facility/Professional Professional Modifier Low / Median / High Price $56.74 / $82.03 / $136.74	Professional		$56.74	$82.03	$136.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.84 / $33.17 / $71.78	Professional	26	$22.84	$33.17	$71.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.88 / $43.56 / $72.70	Professional	TC	$27.88	$43.56	$72.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $48.30 / $55.54 / $69.36	Professional		$48.30	$55.54	$69.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.10 / $34.61 / $43.76	Professional	26	$30.10	$34.61	$43.76
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $20.94 / $26.05	Professional	TC	$18.21	$20.94	$26.05