Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.29 / $155.65 / $211.09	Facility	26	$101.29	$155.65	$211.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $210.52 / $425.00 / $680.00	Professional		$210.52	$425.00	$680.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.51 / $121.07 / $200.64	Professional	26	$70.51	$121.07	$200.64
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $99.20 / $200.00 / $262.50	Professional	52	$99.20	$200.00	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $135.74 / $299.00 / $478.39	Professional	TC	$135.74	$299.00	$478.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.32 / $231.87 / $402.22	Professional		$181.32	$231.87	$402.22
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.23 / $80.27 / $125.42	Professional	26	$64.23	$80.27	$125.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $117.08 / $149.72 / $312.45	Professional	TC	$117.08	$149.72	$312.45
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $310.57 / $317.08 / $1,736.52	Professional		$310.57	$317.08	$1,736.52
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $77.89 / $83.83 / $108.05	Professional	26	$77.89	$83.83	$108.05
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $226.74 / $236.43 / $461.04	Professional	TC	$226.74	$236.43	$461.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.99 / $411.99 / $764.69	Professional		$177.99	$411.99	$764.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.16 / $93.13 / $173.87	Professional	26	$57.16	$93.13	$173.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $119.11 / $270.27 / $655.67	Professional	TC	$119.11	$270.27	$655.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $185.19 / $222.53 / $274.45	Professional		$185.19	$222.53	$274.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.96 / $77.77 / $94.21	Professional	26	$62.96	$77.77	$94.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $122.23 / $146.68 / $179.75	Professional	TC	$122.23	$146.68	$179.75
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $82.26 / $153.66 / $236.33	Facility	26	$82.26	$153.66	$236.33
Medcost Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $275.00 / $710.00	Professional		$100.00	$275.00	$710.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $99.87 / $388.26 / $782.99	Professional		$99.87	$388.26	$782.99
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $75.01 / $99.26 / $157.16	Professional	26	$75.01	$99.26	$157.16
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $143.35 / $266.49 / $538.94	Professional	TC	$143.35	$266.49	$538.94
United Facility/Professional Professional Modifier Low / Median / High Price $175.26 / $317.86 / $760.46	Professional		$175.26	$317.86	$760.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.14 / $88.99 / $148.08	Professional	26	$53.14	$88.99	$148.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.71 / $217.08 / $653.12	Professional	TC	$114.71	$217.08	$653.12