Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $186.09 / $309.63	Facility	26	$118.59	$186.09	$309.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $326.61 / $494.18 / $844.00	Professional		$326.61	$494.18	$844.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.27 / $155.65 / $237.05	Professional	26	$109.27	$155.65	$237.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $158.22 / $212.50 / $265.79	Professional	52	$158.22	$212.50	$265.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $217.91 / $340.00 / $563.67	Professional	TC	$217.91	$340.00	$563.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $301.79 / $385.93 / $638.04	Professional		$301.79	$385.93	$638.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.64 / $123.37 / $190.85	Professional	26	$98.64	$123.37	$190.85
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $203.14 / $259.77 / $472.00	Professional	TC	$203.14	$259.77	$472.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $522.04 / $534.91 / $3,388.21	Professional		$522.04	$534.91	$3,388.21
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $123.09 / $128.68 / $170.75	Professional	26	$123.09	$128.68	$170.75
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $393.38 / $411.39 / $741.03	Professional	TC	$393.38	$411.39	$741.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $123.88	Facility	26	$123.88	$123.88	$123.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $298.18 / $660.60 / $1,399.91	Professional		$298.18	$660.60	$1,399.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.74 / $146.22 / $268.48	Professional	26	$87.74	$146.22	$268.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $207.36 / $467.33 / $1,194.90	Professional	TC	$207.36	$467.33	$1,194.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.62 / $371.55 / $457.63	Professional		$309.62	$371.55	$457.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $97.60 / $120.56 / $145.32	Professional	26	$97.60	$120.56	$145.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $212.02 / $254.43 / $311.80	Professional	TC	$212.02	$254.43	$311.80
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $147.41 / $252.00 / $389.40	Facility	26	$147.41	$252.00	$389.40
Medcost Facility/Professional Professional Modifier Low / Median / High Price $150.16 / $464.00 / $1,136.00	Professional		$150.16	$464.00	$1,136.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $157.63 / $613.75 / $1,354.19	Professional		$157.63	$613.75	$1,354.19
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $115.75 / $156.47 / $243.95	Professional	26	$115.75	$156.47	$243.95
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $250.95 / $466.52 / $828.56	Professional	TC	$250.95	$466.52	$828.56
United Facility/Professional Professional Modifier Low / Median / High Price $294.11 / $536.13 / $1,446.25	Professional		$294.11	$536.13	$1,446.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.54 / $133.38 / $218.33	Professional	26	$86.54	$133.38	$218.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $200.81 / $381.95 / $1,144.04	Professional	TC	$200.81	$381.95	$1,144.04