Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.59 / $155.65 / $211.38	Facility	26	$112.59	$155.65	$211.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $475.00 / $680.00	Professional		$250.00	$475.00	$680.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.97 / $126.00 / $193.79	Professional	26	$70.97	$126.00	$193.79
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $118.33 / $200.00 / $262.50	Professional	52	$118.33	$200.00	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $179.15 / $335.00 / $483.88	Professional	TC	$179.15	$335.00	$483.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $217.27 / $277.85 / $459.36	Professional		$217.27	$277.85	$459.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.70 / $78.81 / $122.65	Professional	26	$62.70	$78.81	$122.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $153.96 / $196.89 / $330.00	Professional	TC	$153.96	$196.89	$330.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $400.65 / $412.56 / $1,570.27	Professional		$400.65	$412.56	$1,570.27
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $74.73 / $79.51 / $99.39	Professional	26	$74.73	$79.51	$99.39
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $318.02 / $333.05 / $516.23	Professional	TC	$318.02	$333.05	$516.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $215.41 / $499.80 / $815.93	Professional		$215.41	$499.80	$815.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.33 / $91.45 / $164.97	Professional	26	$56.33	$91.45	$164.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $157.37 / $403.80 / $669.95	Professional	TC	$157.37	$403.80	$669.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $221.97 / $266.36 / $327.20	Professional		$221.97	$266.36	$327.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.05 / $76.65 / $92.87	Professional	26	$62.05	$76.65	$92.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $159.91 / $191.90 / $235.18	Professional	TC	$159.91	$191.90	$235.18
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $104.24 / $120.00 / $215.35	Facility	26	$104.24	$120.00	$215.35
Medcost Facility/Professional Professional Modifier Low / Median / High Price $98.00 / $421.00 / $784.00	Professional		$98.00	$421.00	$784.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $99.41 / $431.85 / $728.64	Professional		$99.41	$431.85	$728.64
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $73.75 / $97.83 / $154.91	Professional	26	$73.75	$97.83	$154.91
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $193.38 / $359.03 / $524.85	Professional	TC	$193.38	$359.03	$524.85
United Facility/Professional Professional Modifier Low / Median / High Price $214.42 / $383.82 / $788.26	Professional		$214.42	$383.82	$788.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.75 / $89.37 / $148.19	Professional	26	$54.75	$89.37	$148.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.72 / $294.32 / $654.16	Professional	TC	$154.72	$294.32	$654.16