Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.81 / $155.65 / $213.81	Facility	26	$100.81	$155.65	$213.81
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $66.67 / $105.00 / $277.75	Facility	53	$66.67	$105.00	$277.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $215.77 / $425.00 / $680.00	Professional		$215.77	$425.00	$680.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.72 / $118.70 / $177.88	Professional	26	$69.72	$118.70	$177.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $101.66 / $200.00 / $262.50	Professional	52	$101.66	$200.00	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $140.99 / $299.00 / $478.39	Professional	TC	$140.99	$299.00	$478.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.93 / $237.77 / $408.02	Professional		$185.93	$237.77	$408.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.92 / $79.80 / $124.81	Professional	26	$63.92	$79.80	$124.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $122.00 / $156.02 / $318.85	Professional	TC	$122.00	$156.02	$318.85
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $325.68 / $335.42 / $1,586.13	Professional		$325.68	$335.42	$1,586.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $77.13 / $83.40 / $108.05	Professional	26	$77.13	$83.40	$108.05
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $248.55 / $252.02 / $465.01	Professional	TC	$248.55	$252.02	$465.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $182.62 / $421.98 / $773.01	Professional		$182.62	$421.98	$773.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.86 / $92.73 / $173.87	Professional	26	$56.86	$92.73	$173.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.73 / $283.25 / $639.83	Professional	TC	$123.73	$283.25	$639.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.43 / $228.64 / $281.98	Professional		$190.43	$228.64	$281.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.63 / $77.36 / $94.21	Professional	26	$62.63	$77.36	$94.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $127.81 / $153.37 / $187.95	Professional	TC	$127.81	$153.37	$187.95
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $82.26 / $144.00 / $260.00	Facility	26	$82.26	$144.00	$260.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $99.00 / $284.00 / $775.00	Professional		$99.00	$284.00	$775.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $99.74 / $390.35 / $739.59	Professional		$99.74	$390.35	$739.59
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $74.65 / $98.80 / $156.43	Professional	26	$74.65	$98.80	$156.43
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $149.04 / $277.07 / $524.85	Professional	TC	$149.04	$277.07	$524.85
United Facility/Professional Professional Modifier Low / Median / High Price $179.82 / $327.91 / $748.57	Professional		$179.82	$327.91	$748.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.15 / $89.10 / $137.35	Professional	26	$53.15	$89.10	$137.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $119.26 / $227.55 / $588.46	Professional	TC	$119.26	$227.55	$588.46