Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.56 / $100.56 / $129.80	Facility	26	$100.56	$100.56	$129.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $731.63 / $978.39 / $4,352.00	Professional		$731.63	$978.39	$4,352.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.65 / $187.33 / $649.47	Professional	26	$103.65	$187.33	$649.47
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $351.90 / $380.81 / $609.69	Professional	52	$351.90	$380.81	$609.69
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $140.76 / $152.32 / $243.88	Professional	53	$140.76	$152.32	$243.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $617.39 / $788.36 / $1,785.90	Professional	TC	$617.39	$788.36	$1,785.90
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $858.83 / $927.52 / $1,066.65	Professional		$858.83	$927.52	$1,066.65
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $120.82 / $134.46 / $214.41	Professional	26	$120.82	$134.46	$214.41
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $738.02 / $793.06 / $896.16	Professional	TC	$738.02	$793.06	$896.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $686.09 / $1,124.23 / $1,811.23	Professional		$686.09	$1,124.23	$1,811.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.26 / $193.54 / $314.66	Professional	26	$109.26	$193.54	$314.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $586.07 / $943.62 / $1,535.40	Professional	TC	$586.07	$943.62	$1,535.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $724.75 / $934.93 / $1,542.93	Professional		$724.75	$934.93	$1,542.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $110.37 / $143.60 / $226.51	Professional	26	$110.37	$143.60	$226.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $613.42 / $783.77 / $1,338.34	Professional	TC	$613.42	$783.77	$1,338.34
United Facility/Professional Professional Modifier Low / Median / High Price $732.37 / $1,039.17 / $1,696.50	Professional		$732.37	$1,039.17	$1,696.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $111.29 / $159.31 / $264.31	Professional	26	$111.29	$159.31	$264.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $610.48 / $840.63 / $1,492.36	Professional	TC	$610.48	$840.63	$1,492.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $579.79 / $795.62 / $1,029.21	Professional		$579.79	$795.62	$1,029.21
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $89.06 / $118.89 / $162.12	Professional	26	$89.06	$118.89	$162.12
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $490.74 / $678.21 / $867.09	Professional	TC	$490.74	$678.21	$867.09