Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $19.50 / $22.39	Facility	26	$16.22	$19.50	$22.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $74.13 / $295.12	Professional		$54.95	$74.13	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $22.91 / $87.10	Professional	26	$15.85	$22.91	$87.10
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $199.53 / $263.03	Professional	50	$28.84	$199.53	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $44.67 / $77.62	Professional	TC	$38.02	$44.67	$77.62
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $46.77 / $64.57	Professional		$15.14	$46.77	$64.57
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $18.62 / $20.89	Professional	26	$15.49	$18.62	$20.89
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $52.48 / $61.66	Professional	TC	$37.15	$52.48	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $79.43 / $144.54	Professional		$56.23	$79.43	$144.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $23.44 / $41.69	Professional	26	$16.60	$23.44	$41.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $54.95 / $104.71	Professional	TC	$39.81	$54.95	$104.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $74.13 / $102.33	Professional		$51.29	$74.13	$102.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $20.42 / $28.84	Professional	26	$14.45	$20.42	$28.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $53.70 / $74.13	Professional	TC	$37.15	$53.70	$74.13
United Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $72.44 / $131.83	Professional		$51.29	$72.44	$131.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $21.88 / $38.02	Professional	26	$14.79	$21.88	$38.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $51.29 / $93.33	Professional	TC	$35.48	$51.29	$93.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $79.43 / $100.00	Professional		$47.86	$79.43	$100.00
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $21.88 / $27.54	Professional	26	$14.13	$21.88	$27.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $56.23 / $74.13	Professional	TC	$33.88	$56.23	$74.13