Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $69.18 / $125.89	Facility	26	$39.81	$69.18	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $144.54 / $346.74	Professional		$89.13	$144.54	$346.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $66.07 / $186.21	Professional	26	$41.69	$66.07	$186.21
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.67 / $93.33 / $630.96	Professional	52	$44.67	$93.33	$630.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $75.86 / $186.21	Professional	TC	$43.65	$75.86	$186.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $128.82 / $234.42	Professional		$95.50	$128.82	$234.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $58.88 / $104.71	Professional	26	$43.65	$58.88	$104.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $69.18 / $125.89	Professional	TC	$52.48	$69.18	$125.89
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $112.20 / $588.84	Professional		$47.86	$112.20	$588.84
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $53.70 / $67.61	Professional	26	$42.66	$53.70	$67.61
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $67.61 / $91.20	Professional	TC	$64.57	$67.61	$91.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $70.79	Facility	26	$10.47	$48.98	$70.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $190.55 / $316.23	Professional		$93.33	$190.55	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $75.86 / $123.03	Professional	26	$41.69	$75.86	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $114.82 / $190.55	Professional	TC	$51.29	$114.82	$190.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $117.49 / $151.36	Professional		$93.33	$117.49	$151.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $48.98 / $63.10	Professional	26	$38.90	$48.98	$63.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $69.18 / $85.11	Professional	TC	$54.95	$69.18	$85.11
Medcost Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $281.84 / $331.13	Professional		$229.09	$281.84	$331.13
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $125.89 / $125.89	Professional	26	$102.33	$125.89	$125.89
Medcost Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $457.09 / $457.09	Professional		$457.09	$457.09	$457.09
Sentara Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $147.91 / $398.11	Professional		$66.07	$147.91	$398.11
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $70.79 / $109.65	Professional	26	$44.67	$70.79	$109.65
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $107.15 / $177.83	Professional	TC	$54.95	$107.15	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $181.97 / $302.00	Professional		$100.00	$181.97	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $69.18 / $114.82	Professional	26	$39.81	$69.18	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $112.20 / $186.21	Professional	TC	$61.66	$112.20	$186.21