Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.42 / $274.57 / $472.66	Facility	26	$107.42	$274.57	$472.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $585.24 / $650.50 / $1,473.15	Professional		$585.24	$650.50	$1,473.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.42 / $115.41 / $166.89	Professional	26	$107.42	$115.41	$166.89
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $284.48 / $304.37 / $320.01	Professional	52	$284.48	$304.37	$320.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $462.32 / $524.61 / $773.12	Professional	TC	$462.32	$524.61	$773.12
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $655.91 / $728.79 / $1,711.19	Professional		$655.91	$728.79	$1,711.19
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $117.05 / $130.05 / $214.58	Professional	26	$117.05	$130.05	$214.58
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $538.87 / $598.74 / $987.92	Professional	TC	$538.87	$598.74	$987.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $718.15 / $1,388.15 / $1,920.55	Professional		$718.15	$1,388.15	$1,920.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.50 / $272.25 / $566.29	Professional	26	$123.50	$272.25	$566.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $594.65 / $1,138.08 / $1,581.64	Professional	TC	$594.65	$1,138.08	$1,581.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $678.44 / $1,486.64 / $1,486.64	Professional		$678.44	$1,486.64	$1,486.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $116.67 / $256.89 / $256.89	Professional	26	$116.67	$256.89	$256.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $561.77 / $1,229.74 / $1,229.74	Professional	TC	$561.77	$1,229.74	$1,229.74
United Facility/Professional Professional Modifier Low / Median / High Price $574.99 / $874.53 / $1,882.60	Professional		$574.99	$874.53	$1,882.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.35 / $157.65 / $325.32	Professional	26	$109.35	$157.65	$325.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $471.87 / $1,235.00 / $1,557.28	Professional	TC	$471.87	$1,235.00	$1,557.28