Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.65 / $250.83 / $281.32	Facility	26	$103.65	$250.83	$281.32
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $152.32 / $152.32 / $152.32	Facility	53	$152.32	$152.32	$152.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $703.79 / $761.62 / $1,843.12	Professional		$703.79	$761.62	$1,843.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.57 / $103.65 / $187.33	Professional	26	$100.57	$103.65	$187.33
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $351.90 / $380.81 / $380.81	Professional	52	$351.90	$380.81	$380.81
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $140.76 / $152.32 / $152.32	Professional	53	$140.76	$152.32	$152.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $603.22 / $657.97 / $842.20	Professional	TC	$603.22	$657.97	$842.20
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $858.83 / $927.52 / $2,786.09	Professional		$858.83	$927.52	$2,786.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $120.82 / $134.46 / $199.98	Professional	26	$120.82	$134.46	$199.98
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $738.02 / $793.06 / $865.70	Professional	TC	$738.02	$793.06	$865.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $747.88 / $1,110.41 / $2,447.34	Professional		$747.88	$1,110.41	$2,447.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.37 / $215.01 / $378.05	Professional	26	$110.37	$215.01	$378.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $637.52 / $945.41 / $2,113.05	Professional	TC	$637.52	$945.41	$2,113.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $755.84 / $875.18 / $1,745.74	Professional		$755.84	$875.18	$1,745.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $111.54 / $129.15 / $245.59	Professional	26	$111.54	$129.15	$245.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $644.29 / $746.03 / $1,500.17	Professional	TC	$644.29	$746.03	$1,500.17
United Facility/Professional Professional Modifier Low / Median / High Price $732.37 / $1,323.28 / $2,508.90	Professional		$732.37	$1,323.28	$2,508.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $116.80 / $230.14 / $346.02	Professional	26	$116.80	$230.14	$346.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $623.65 / $1,748.36 / $1,899.72	Professional	TC	$623.65	$1,748.36	$1,899.72