Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.14 / $155.65 / $783.57	Facility	26	$106.14	$155.65	$783.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.68 / $422.91 / $680.00	Professional		$199.68	$422.91	$680.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.54 / $118.59 / $184.54	Professional	26	$65.54	$118.59	$184.54
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $811.00 / $1,711.00 / $5,116.00	Professional	50	$811.00	$1,711.00	$5,116.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.71 / $200.00 / $262.50	Professional	52	$104.71	$200.00	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.29 / $299.00 / $478.39	Professional	TC	$154.29	$299.00	$478.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $192.08 / $245.63 / $409.21	Professional		$192.08	$245.63	$409.21
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 $288.12 / $368.44 / $609.15	Professional	50	$288.12	$368.44	$609.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $133.37 / $170.56 / $318.83	Professional	TC	$133.37	$170.56	$318.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $334.91 / $337.57 / $1,548.01	Professional		$334.91	$337.57	$1,548.01
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $72.03 / $74.52 / $92.76	Professional	26	$72.03	$74.52	$92.76
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $258.29 / $263.36 / $408.21	Professional	TC	$258.29	$263.36	$408.21
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 $176.52 / $419.06 / $739.74	Professional		$176.52	$419.06	$739.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.25 / $83.32 / $143.49	Professional	26	$52.25	$83.32	$143.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $135.46 / $302.88 / $631.20	Professional	TC	$135.46	$302.88	$631.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $197.80 / $237.35 / $291.77	Professional		$197.80	$237.35	$291.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.55 / $71.09 / $86.16	Professional	26	$57.55	$71.09	$86.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $140.25 / $168.30 / $206.25	Professional	TC	$140.25	$168.30	$206.25
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $84.02 / $142.71 / $231.15	Facility	26	$84.02	$142.71	$231.15
Medcost Facility/Professional Professional Modifier Low / Median / High Price $91.00 / $291.00 / $742.00	Professional		$91.00	$291.00	$742.00
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 / $91.13 / $144.30	Professional	26	$68.15	$91.13	$144.30
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 $184.41 / $310.72 / $721.14	Professional		$184.41	$310.72	$721.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.32 / $77.92 / $125.22	Professional	26	$48.32	$77.92	$125.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $129.27 / $245.89 / $600.23	Professional	TC	$129.27	$245.89	$600.23