Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $154.88 / $281.84	Facility	26	$114.82	$154.88	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $416.87 / $1,230.27	Professional		$194.98	$416.87	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $117.49 / $257.04	Professional	26	$66.07	$117.49	$257.04
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $162.18 / $870.96	Professional	52	$123.03	$162.18	$870.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $245.47 / $562.34	Professional	TC	$123.03	$245.47	$562.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $263.03 / $467.74	Professional		$190.55	$263.03	$467.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $89.13 / $144.54	Professional	26	$67.61	$89.13	$144.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $169.82 / $323.59	Professional	TC	$123.03	$169.82	$323.59
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $281.84 / $1,778.28	Professional		$87.10	$281.84	$1,778.28
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $95.50 / $134.90	Professional	26	$75.86	$95.50	$134.90
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $186.21 / $295.12	Professional	TC	$165.96	$186.21	$295.12
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 Professional Modifier Low / Median / High Price $177.83 / $416.87 / $724.44	Professional		$177.83	$416.87	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $93.33 / $165.96	Professional	26	$56.23	$93.33	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $275.42 / $602.56	Professional	TC	$117.49	$275.42	$602.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $223.87 / $281.84	Professional		$186.21	$223.87	$281.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $77.62 / $100.00	Professional	26	$63.10	$77.62	$100.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $147.91 / $190.55	Professional	TC	$120.23	$147.91	$190.55
Medcost Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $794.33 / $812.83	Professional		$457.09	$794.33	$812.83
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $141.25 / $151.36	Professional	26	$112.20	$141.25	$151.36
Medcost Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $323.59 / $446.68	Professional		$323.59	$323.59	$446.68
Sentara Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $323.59 / $1,445.44	Professional		$91.20	$323.59	$1,445.44
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $95.50 / $158.49	Professional	26	$72.44	$95.50	$158.49
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $263.03 / $512.86	Professional	TC	$134.90	$263.03	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $316.23 / $776.25	Professional		$173.78	$316.23	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $83.18 / $147.91	Professional	26	$47.86	$83.18	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $218.78 / $616.60	Professional	TC	$114.82	$218.78	$616.60