Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $141.25	Facility	26	$100.00	$100.00	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $1,148.15 / $3,311.31	Professional		$741.31	$1,148.15	$3,311.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $218.78 / $660.69	Professional	26	$112.20	$218.78	$660.69
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $275.42 / $891.25 / $1,479.11	Professional	52	$275.42	$891.25	$1,479.11
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $398.11 / $549.54 / $549.54	Professional	53	$398.11	$549.54	$549.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $776.25 / $1,698.24	Professional	TC	$616.60	$776.25	$1,698.24
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $776.25 / $954.99	Professional		$213.80	$776.25	$954.99
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $117.49 / $181.97	Professional	26	$104.71	$117.49	$181.97
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $676.08 / $676.08 / $870.96	Professional	TC	$676.08	$676.08	$870.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $177.83 / $177.83	Facility	26	$177.83	$177.83	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $1,071.52 / $2,041.74	Professional		$676.08	$1,071.52	$2,041.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $190.55 / $331.13	Professional	26	$107.15	$190.55	$331.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $891.25 / $1,659.59	Professional	TC	$575.44	$891.25	$1,659.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $977.24 / $1,288.25	Professional		$851.14	$977.24	$1,288.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $134.90 / $213.80	Professional	26	$123.03	$134.90	$213.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $831.76 / $1,096.48	Professional	TC	$724.44	$831.76	$1,096.48
United Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,071.52 / $1,778.28	Professional		$724.44	$1,071.52	$1,778.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $173.78 / $275.42	Professional	26	$112.20	$173.78	$275.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $870.96 / $1,513.56	Professional	TC	$616.60	$870.96	$1,513.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $977.24 / $1,258.93	Professional		$724.44	$977.24	$1,258.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $141.25 / $177.83	Professional	26	$112.20	$141.25	$177.83
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $851.14 / $1,096.48	Professional	TC	$616.60	$851.14	$1,096.48