Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.08 / $146.12 / $211.09	Facility	26	$93.08	$146.12	$211.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.97 / $422.27 / $674.95	Professional		$199.97	$422.27	$674.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.04 / $118.59 / $184.54	Professional	26	$65.04	$118.59	$184.54
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $200.00 / $1,380.10 / $5,004.00	Professional	50	$200.00	$1,380.10	$5,004.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.87 / $200.00 / $262.50	Professional	52	$104.87	$200.00	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.29 / $299.00 / $458.04	Professional	TC	$154.29	$299.00	$458.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $192.38 / $246.02 / $409.86	Professional		$192.38	$246.02	$409.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.01 / $73.06 / $114.61	Professional	26	$58.01	$73.06	$114.61
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $288.58 / $369.03 / $610.11	Professional	50	$288.58	$369.03	$610.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $133.69 / $170.96 / $318.83	Professional	TC	$133.69	$170.96	$318.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $334.86 / $337.04 / $1,548.01	Professional		$334.86	$337.04	$1,548.01
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $72.03 / $76.63 / $96.05	Professional	26	$72.03	$76.63	$96.05
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $258.89 / $262.83 / $461.79	Professional	TC	$258.89	$262.83	$461.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.36 / $427.28 / $739.74	Professional		$189.36	$427.28	$739.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.25 / $84.83 / $154.84	Professional	26	$52.25	$84.83	$154.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $135.46 / $304.58 / $627.71	Professional	TC	$135.46	$304.58	$627.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $198.13 / $237.75 / $292.24	Professional		$198.13	$237.75	$292.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.55 / $71.09 / $86.65	Professional	26	$57.55	$71.09	$86.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $140.58 / $168.70 / $206.74	Professional	TC	$140.58	$168.70	$206.74
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $96.48 / $142.71 / $264.00	Facility	26	$96.48	$142.71	$264.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $91.88 / $292.00 / $728.00	Professional		$91.88	$292.00	$728.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $92.60 / $394.53 / $722.38	Professional		$92.60	$394.53	$722.38
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $68.15 / $91.61 / $145.06	Professional	26	$68.15	$91.61	$145.06
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $161.56 / $300.33 / $524.85	Professional	TC	$161.56	$300.33	$524.85
United Facility/Professional Professional Modifier Low / Median / High Price $185.22 / $332.32 / $815.97	Professional		$185.22	$332.32	$815.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.62 / $77.93 / $130.71	Professional	26	$50.62	$77.93	$130.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $129.27 / $238.91 / $582.16	Professional	TC	$129.27	$238.91	$582.16