Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $79.43 / $218.78	Facility	26	$45.71	$79.43	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $199.53 / $602.56	Professional		$114.82	$199.53	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $54.95 / $165.96	Professional	26	$46.77	$54.95	$165.96
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $85.11 / $144.54 / $144.54	Professional	52	$85.11	$144.54	$144.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $120.23 / $316.23	Professional	TC	$79.43	$120.23	$316.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $186.21 / $323.59	Professional		$131.83	$186.21	$323.59
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $66.07 / $104.71	Professional	26	$48.98	$66.07	$104.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $114.82 / $194.98	Professional	TC	$83.18	$114.82	$194.98
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $190.55 / $912.01	Professional		$109.65	$190.55	$912.01
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $66.07 / $93.33	Professional	26	$56.23	$66.07	$93.33
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $154.88 / $204.17	Professional	TC	$138.04	$154.88	$204.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $57.54 / $83.18	Facility	26	$12.59	$57.54	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $269.15 / $436.52	Professional		$125.89	$269.15	$436.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $66.07 / $117.49	Professional	26	$39.81	$66.07	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $181.97 / $316.23	Professional	TC	$81.28	$181.97	$316.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $154.88 / $194.98	Professional		$128.82	$154.88	$194.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $56.23 / $72.44	Professional	26	$45.71	$56.23	$72.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $100.00 / $128.82	Professional	TC	$81.28	$100.00	$128.82
Medcost Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $436.52 / $457.09	Professional		$309.03	$436.52	$457.09
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $102.33 / $109.65	Professional	26	$81.28	$102.33	$109.65
Medcost Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $223.87	Professional		$223.87	$223.87	$223.87
Sentara Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $213.80 / $1,148.15	Professional		$66.07	$213.80	$1,148.15
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $69.18 / $112.20	Professional	26	$51.29	$69.18	$112.20
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $177.83 / $281.84	Professional	TC	$93.33	$177.83	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $218.78 / $416.87	Professional		$125.89	$218.78	$416.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $64.57 / $109.65	Professional	26	$37.15	$64.57	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $147.91 / $323.59	Professional	TC	$81.28	$147.91	$323.59