Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.40 / $66.17 / $154.47	Facility	26	$53.40	$66.17	$154.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $308.27 / $415.39 / $541.49	Professional		$308.27	$415.39	$541.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.32 / $59.49 / $75.98	Professional	26	$50.32	$59.49	$75.98
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $154.13 / $206.91 / $269.69	Professional	52	$154.13	$206.91	$269.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.94 / $351.36 / $461.97	Professional	TC	$257.94	$351.36	$461.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $369.79 / $472.75 / $731.32	Professional		$369.79	$472.75	$731.32
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.31 / $66.94 / $103.51	Professional	26	$52.31	$66.94	$103.51
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $317.48 / $405.87 / $627.86	Professional	TC	$317.48	$405.87	$627.86
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $491.58 / $540.74 / $1,201.98	Professional		$491.58	$540.74	$1,201.98
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $66.52 / $66.52 / $129.71	Professional	26	$66.52	$66.52	$129.71
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $425.06 / $425.06 / $828.87	Professional	TC	$425.06	$425.06	$828.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $402.43 / $603.65 / $960.02	Professional		$402.43	$603.65	$960.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.45 / $90.21 / $138.96	Professional	26	$56.45	$90.21	$138.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $345.05 / $523.59 / $827.09	Professional	TC	$345.05	$523.59	$827.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $402.19 / $473.86 / $615.11	Professional		$402.19	$473.86	$615.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.92 / $64.13 / $79.40	Professional	26	$51.92	$64.13	$79.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $350.27 / $412.08 / $535.70	Professional	TC	$350.27	$412.08	$535.70
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $70.69 / $103.00 / $163.56	Facility	26	$70.69	$103.00	$163.56
Medcost Facility/Professional Professional Modifier Low / Median / High Price $80.39 / $560.00 / $809.00	Professional		$80.39	$560.00	$809.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $86.97 / $540.04 / $879.86	Professional		$86.97	$540.04	$879.86
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $64.29 / $87.63 / $133.03	Professional	26	$64.29	$87.63	$133.03
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $368.40 / $526.39 / $751.99	Professional	TC	$368.40	$526.39	$751.99
United Facility/Professional Professional Modifier Low / Median / High Price $373.99 / $608.88 / $886.81	Professional		$373.99	$608.88	$886.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.95 / $88.22 / $132.13	Professional	26	$51.95	$88.22	$132.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $309.06 / $496.13 / $758.54	Professional	TC	$309.06	$496.13	$758.54