Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $147.91 / $354.81	Facility	26	$79.43	$147.91	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $316.23 / $660.69	Professional		$208.93	$316.23	$660.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $128.82 / $338.84	Professional	26	$79.43	$128.82	$338.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $331.13 / $1,819.70 / $2,951.21	Professional	50	$331.13	$1,819.70	$2,951.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $218.78 / $512.86	Professional	TC	$162.18	$218.78	$512.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $436.52 / $676.08	Professional		$309.03	$436.52	$676.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $112.20 / $181.97	Professional	26	$81.28	$112.20	$181.97
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $457.09 / $645.65 / $1,023.29	Professional	50	$457.09	$645.65	$1,023.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $316.23 / $501.19	Professional	TC	$223.87	$316.23	$501.19
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $416.87 / $1,621.81	Professional		$316.23	$416.87	$1,621.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $114.82 / $162.18	Professional	26	$97.72	$114.82	$162.18
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $436.52 / $537.03	Professional	TC	$302.00	$436.52	$537.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $102.33 / $144.54	Facility	26	$21.88	$102.33	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $512.86 / $870.96	Professional		$295.12	$512.86	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $112.20 / $194.98	Professional	26	$69.18	$112.20	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $398.11 / $676.08	Professional	TC	$218.78	$398.11	$676.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $380.19 / $489.78	Professional		$316.23	$380.19	$489.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $100.00 / $125.89	Professional	26	$79.43	$100.00	$125.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $281.84 / $363.08	Professional	TC	$229.09	$281.84	$363.08
Medcost Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $776.25 / $794.33	Professional		$630.96	$776.25	$794.33
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $165.96 / $190.55	Professional	26	$131.83	$165.96	$190.55
Medcost Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $426.58	Professional		$275.42	$275.42	$426.58
Sentara Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $389.05 / $1,258.93	Professional		$114.82	$389.05	$1,258.93
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $123.03 / $199.53	Professional	26	$91.20	$123.03	$199.53
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $331.13 / $524.81	Professional	TC	$177.83	$331.13	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $446.68 / $794.33	Professional		$281.84	$446.68	$794.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $104.71 / $177.83	Professional	26	$60.26	$104.71	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $338.84 / $645.65	Professional	TC	$208.93	$338.84	$645.65