Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $155.65 / $293.82	Facility	26	$118.59	$155.65	$293.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $276.35 / $425.00 / $640.50	Professional		$276.35	$425.00	$640.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.70 / $126.00 / $156.54	Professional	26	$84.70	$126.00	$156.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $133.54 / $203.72 / $262.50	Professional	52	$133.54	$203.72	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $191.40 / $299.00 / $415.60	Professional	TC	$191.40	$299.00	$415.60
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $256.30 / $327.76 / $541.88	Professional		$256.30	$327.76	$541.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.83 / $96.08 / $148.63	Professional	26	$76.83	$96.08	$148.63
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $179.47 / $229.51 / $386.73	Professional	TC	$179.47	$229.51	$386.73
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $447.79 / $456.16 / $1,902.91	Professional		$447.79	$456.16	$1,902.91
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $90.22 / $96.33 / $120.41	Professional	26	$90.22	$96.33	$120.41
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $347.55 / $359.83 / $469.83	Professional	TC	$347.55	$359.83	$469.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $253.94 / $558.88 / $938.82	Professional		$253.94	$558.88	$938.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.34 / $111.66 / $205.00	Professional	26	$68.34	$111.66	$205.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $182.98 / $407.90 / $755.29	Professional	TC	$182.98	$407.90	$755.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.37 / $316.05 / $388.49	Professional		$263.37	$316.05	$388.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.59 / $93.39 / $113.53	Professional	26	$75.59	$93.39	$113.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $187.77 / $225.33 / $276.14	Professional	TC	$187.77	$225.33	$276.14
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $127.26 / $148.00 / $264.14	Facility	26	$127.26	$148.00	$264.14
Medcost Facility/Professional Professional Modifier Low / Median / High Price $117.19 / $394.00 / $865.00	Professional		$117.19	$394.00	$865.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $120.94 / $433.71 / $884.57	Professional		$120.94	$433.71	$884.57
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $89.54 / $119.70 / $189.53	Professional	26	$89.54	$119.70	$189.53
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $220.19 / $329.37 / $585.54	Professional	TC	$220.19	$329.37	$585.54
United Facility/Professional Professional Modifier Low / Median / High Price $248.82 / $468.66 / $836.02	Professional		$248.82	$468.66	$836.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.41 / $103.69 / $178.05	Professional	26	$66.41	$103.69	$178.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $176.19 / $326.42 / $705.89	Professional	TC	$176.19	$326.42	$705.89