Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.78 / $442.20 / $561.12	Facility		$151.78	$442.20	$561.12
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $68.34 / $297.68 / $404.98	Facility	TC	$68.34	$297.68	$404.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.20 / $61.91 / $167.03	Professional		$34.20	$61.91	$167.03
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.85 / $25.47 / $60.30	Professional	26	$19.85	$25.47	$60.30
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $234.74	Professional	50	$234.74	$234.74	$234.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.21 / $23.73 / $42.55	Professional	52	$17.21	$23.73	$42.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.14 / $49.70 / $125.13	Professional	TC	$17.14	$49.70	$125.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $43.43 / $48.25 / $61.76	Professional		$43.43	$48.25	$61.76
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $16.14 / $23.59 / $29.96	Professional	26	$16.14	$23.59	$29.96
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $21.81 / $24.66 / $39.83	Professional	TC	$21.81	$24.66	$39.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $93.25 / $93.25 / $93.25	Facility		$93.25	$93.25	$93.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.99 / $74.45 / $132.34	Professional		$31.99	$74.45	$132.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $27.97 / $52.13	Professional	26	$17.38	$27.97	$52.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.27 / $42.80 / $83.23	Professional	TC	$14.27	$42.80	$83.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.76 / $48.71 / $86.48	Professional		$37.76	$48.71	$86.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.59 / $24.71 / $40.04	Professional	26	$20.59	$24.71	$40.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $17.16 / $22.14 / $54.53	Professional	TC	$17.16	$22.14	$54.53
United Facility/Professional Professional Modifier Low / Median / High Price $40.14 / $58.18 / $94.65	Professional		$40.14	$58.18	$94.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.09 / $23.19 / $42.44	Professional	26	$17.09	$23.19	$42.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.92 / $34.88 / $60.54	Professional	TC	$20.92	$34.88	$60.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $30.21 / $40.65 / $54.11	Professional		$30.21	$40.65	$54.11
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $16.47 / $21.98 / $29.97	Professional	26	$16.47	$21.98	$29.97
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $13.73 / $18.89 / $24.13	Professional	TC	$13.73	$18.89	$24.13