Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $42.66 / $87.10	Facility	26	$32.36	$42.66	$87.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $181.97 / $407.38	Professional		$107.15	$181.97	$407.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $48.98 / $120.23	Professional	26	$32.36	$48.98	$120.23
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $18.20 / $61.66 / $562.34	Professional	52	$18.20	$61.66	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $102.33 / $234.42	Professional	TC	$77.62	$102.33	$234.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $165.96 / $251.19	Professional		$117.49	$165.96	$251.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $45.71 / $70.79	Professional	26	$33.11	$45.71	$70.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $117.49 / $186.21	Professional	TC	$87.10	$117.49	$186.21
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $144.54 / $245.47	Professional		$56.23	$144.54	$245.47
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $38.02 / $53.70	Professional	26	$34.67	$38.02	$53.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $151.36	Professional	TC	$95.50	$95.50	$151.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $41.69 / $58.88	Facility	26	$8.91	$41.69	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $165.96 / $275.42	Professional		$102.33	$165.96	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $45.71 / $77.62	Professional	26	$28.18	$45.71	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $123.03 / $199.53	Professional	TC	$74.13	$123.03	$199.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $147.91 / $181.97	Professional		$123.03	$147.91	$181.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $39.81 / $48.98	Professional	26	$32.36	$39.81	$48.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $109.65 / $134.90	Professional	TC	$89.13	$109.65	$134.90
Medcost Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $281.84 / $281.84	Professional		$281.84	$281.84	$281.84
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $77.62 / $77.62	Professional	26	$77.62	$77.62	$77.62
Medcost Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $208.93 / $323.59	Professional		$208.93	$208.93	$323.59
Sentara Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $144.54 / $281.84	Professional		$45.71	$144.54	$281.84
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $47.86 / $81.28	Professional	26	$37.15	$47.86	$81.28
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $123.03 / $208.93	Professional	TC	$95.50	$123.03	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $165.96 / $257.04	Professional		$107.15	$165.96	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $43.65 / $70.79	Professional	26	$28.18	$43.65	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $117.49 / $190.55	Professional	TC	$77.62	$117.49	$190.55