Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.76 / $77.79 / $157.50	Facility	26	$45.76	$77.79	$157.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.33 / $168.77 / $335.50	Professional		$131.33	$168.77	$335.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.76 / $59.38 / $110.74	Professional	26	$45.76	$59.38	$110.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $63.41 / $79.59 / $137.50	Professional	52	$63.41	$79.59	$137.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.87 / $104.42 / $220.00	Professional	TC	$81.87	$104.42	$220.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.69 / $160.74 / $265.75	Professional		$125.69	$160.74	$265.75
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.71 / $58.32 / $90.38	Professional	26	$46.71	$58.32	$90.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.98 / $101.00 / $176.47	Professional	TC	$78.98	$101.00	$176.47
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $188.86 / $225.75 / $891.04	Professional		$188.86	$225.75	$891.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $53.02 / $58.85 / $74.23	Professional	26	$53.02	$58.85	$74.23
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $122.36 / $172.73 / $219.37	Professional	TC	$122.36	$172.73	$219.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.94 / $279.35 / $427.40	Professional		$115.94	$279.35	$427.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.54 / $67.93 / $126.73	Professional	26	$41.54	$67.93	$126.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.94 / $189.37 / $332.07	Professional	TC	$80.94	$189.37	$332.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.68 / $154.91 / $191.05	Professional		$128.68	$154.91	$191.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.77 / $56.54 / $68.63	Professional	26	$45.77	$56.54	$68.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.91 / $99.49 / $121.93	Professional	TC	$82.91	$99.49	$121.93
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $83.03 / $112.00 / $173.00	Facility	26	$83.03	$112.00	$173.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $69.00 / $194.00 / $390.00	Professional		$69.00	$194.00	$390.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $76.73 / $245.30 / $434.98	Professional		$76.73	$245.30	$434.98
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $52.36 / $75.28 / $114.83	Professional	26	$52.36	$75.28	$114.83
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $100.45 / $186.50 / $288.25	Professional	TC	$100.45	$186.50	$288.25
United Facility/Professional Professional Modifier Low / Median / High Price $127.47 / $214.57 / $394.24	Professional		$127.47	$214.57	$394.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.21 / $69.08 / $106.88	Professional	26	$41.21	$69.08	$106.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.37 / $142.41 / $310.47	Professional	TC	$80.37	$142.41	$310.47