Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $190.55 / $338.84	Facility	26	$112.20	$190.55	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $741.31 / $1,412.54	Professional		$575.44	$741.31	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $173.78 / $467.74	Professional	26	$114.82	$173.78	$467.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $239.88 / $512.86 / $1,258.93	Professional	52	$239.88	$512.86	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $575.44 / $1,071.52	Professional	TC	$457.09	$575.44	$1,071.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $870.96 / $1,548.82	Professional		$616.60	$870.96	$1,548.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $158.49 / $295.12	Professional	26	$114.82	$158.49	$295.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $707.95 / $1,258.93	Professional	TC	$489.78	$707.95	$1,258.93
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $794.33 / $2,951.21	Professional		$120.23	$794.33	$2,951.21
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $134.90 / $158.49	Professional	26	$134.90	$134.90	$158.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $645.65 / $933.25	Professional	TC	$588.84	$645.65	$933.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $138.04 / $199.53	Facility	26	$29.51	$138.04	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $954.99 / $1,445.44	Professional		$630.96	$954.99	$1,445.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $181.97 / $309.03	Professional	26	$117.49	$181.97	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $758.58 / $1,174.90	Professional	TC	$512.86	$758.58	$1,174.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $831.76 / $1,047.13	Professional		$660.69	$831.76	$1,047.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $141.25 / $181.97	Professional	26	$107.15	$141.25	$181.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $691.83 / $891.25	Professional	TC	$549.54	$691.83	$891.25
Medcost Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,174.90 / $1,288.25	Professional		$933.25	$1,174.90	$1,288.25
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $288.40 / $295.12	Professional	26	$234.42	$288.40	$295.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $676.08 / $676.08	Professional		$676.08	$676.08	$676.08
Sentara Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $812.83 / $2,570.40	Professional		$165.96	$812.83	$2,570.40
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $177.83 / $275.42	Professional	26	$123.03	$177.83	$275.42
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $741.31 / $1,148.15	Professional	TC	$524.81	$741.31	$1,148.15
United Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $912.01 / $1,445.44	Professional		$575.44	$912.01	$1,445.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $177.83 / $281.84	Professional	26	$109.65	$177.83	$281.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $741.31 / $1,174.90	Professional	TC	$467.74	$741.31	$1,174.90