Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $147.91 / $281.84	Facility	26	$114.82	$147.91	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $380.19 / $1,000.00	Professional		$199.53	$380.19	$1,000.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $97.72 / $251.19	Professional	26	$66.07	$97.72	$251.19
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $75.86 / $125.89 / $363.08	Professional	52	$75.86	$125.89	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $257.04 / $524.81	Professional	TC	$131.83	$257.04	$524.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $275.42 / $478.63	Professional		$194.98	$275.42	$478.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $89.13 / $144.54	Professional	26	$66.07	$89.13	$144.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $177.83 / $323.59	Professional	TC	$128.82	$177.83	$323.59
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $288.40 / $1,584.89	Professional		$177.83	$288.40	$1,584.89
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $95.50 / $134.90	Professional	26	$87.10	$95.50	$134.90
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $245.47 / $302.00	Professional	TC	$223.87	$245.47	$302.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $22.91 / $40.74 / $61.66	Facility	53	$22.91	$40.74	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $426.58 / $758.58	Professional		$181.97	$426.58	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $89.13 / $158.49	Professional	26	$54.95	$89.13	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $295.12 / $645.65	Professional	TC	$123.03	$295.12	$645.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $229.09 / $295.12	Professional		$190.55	$229.09	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $77.62 / $97.72	Professional	26	$63.10	$77.62	$97.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $154.88 / $199.53	Professional	TC	$125.89	$154.88	$199.53
Medcost Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $776.25 / $794.33	Professional		$467.74	$776.25	$794.33
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $131.83 / $151.36	Professional	26	$104.71	$131.83	$151.36
Medcost Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $331.13 / $446.68	Professional		$331.13	$331.13	$446.68
Sentara Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $331.13 / $1,778.28	Professional		$91.20	$331.13	$1,778.28
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $93.33 / $154.88	Professional	26	$72.44	$93.33	$154.88
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $275.42 / $512.86	Professional	TC	$138.04	$275.42	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $323.59 / $794.33	Professional		$177.83	$323.59	$794.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $83.18 / $144.54	Professional	26	$47.86	$83.18	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $229.09 / $676.08	Professional	TC	$120.23	$229.09	$676.08