Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.20 / $64.43 / $141.11	Facility	26	$36.20	$64.43	$141.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.37 / $151.22 / $307.52	Professional		$127.37	$151.22	$307.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.20 / $51.30 / $96.16	Professional	26	$36.20	$51.30	$96.16
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.63 / $69.78 / $137.50	Professional	52	$60.63	$69.78	$137.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.29 / $106.59 / $220.00	Professional	TC	$87.29	$106.59	$220.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $121.08 / $154.84 / $255.99	Professional		$121.08	$154.84	$255.99
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.86 / $47.16 / $77.95	Professional	26	$36.86	$47.16	$77.95
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $84.20 / $107.68 / $180.00	Professional	TC	$84.20	$107.68	$180.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $182.96 / $196.52 / $742.40	Professional		$182.96	$196.52	$742.40
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.51 / $59.75 / $77.91	Professional	26	$52.51	$59.75	$77.91
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $130.44 / $136.77 / $173.70	Professional	TC	$130.44	$136.77	$173.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.27 / $46.27 / $46.27	Facility	26	$46.27	$46.27	$46.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.28 / $251.80 / $389.03	Professional		$111.28	$251.80	$389.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.53 / $62.29 / $107.60	Professional	26	$33.53	$62.29	$107.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.86 / $178.45 / $300.23	Professional	TC	$83.86	$178.45	$300.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $124.63 / $149.55 / $183.90	Professional		$124.63	$149.55	$183.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.47 / $45.06 / $54.30	Professional	26	$36.47	$45.06	$54.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $88.15 / $105.78 / $129.63	Professional	TC	$88.15	$105.78	$129.63
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $47.43 / $111.00 / $155.27	Facility	26	$47.43	$111.00	$155.27
Medcost Facility/Professional Professional Modifier Low / Median / High Price $58.00 / $171.00 / $374.00	Professional		$58.00	$171.00	$374.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $73.73 / $227.22 / $435.11	Professional		$73.73	$227.22	$435.11
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $43.18 / $64.20 / $95.06	Professional	26	$43.18	$64.20	$95.06
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $95.68 / $179.41 / $289.38	Professional	TC	$95.68	$179.41	$289.38
United Facility/Professional Professional Modifier Low / Median / High Price $112.22 / $197.67 / $378.83	Professional		$112.22	$197.67	$378.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.94 / $52.50 / $88.21	Professional	26	$33.94	$52.50	$88.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.22 / $136.32 / $279.41	Professional	TC	$77.22	$136.32	$279.41