Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $100.00 / $239.88	Facility	26	$54.95	$100.00	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $245.47 / $660.69	Professional		$154.88	$245.47	$660.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $93.33 / $208.93	Professional	26	$56.23	$93.33	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $131.83 / $309.03	Professional	TC	$100.00	$131.83	$309.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $218.78 / $363.08	Professional		$158.49	$218.78	$363.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $125.89	Professional	26	$57.54	$77.62	$125.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $138.04 / $229.09	Professional	TC	$100.00	$138.04	$229.09
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $204.17 / $758.58	Professional		$70.79	$204.17	$758.58
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $79.43 / $120.23	Professional	26	$61.66	$79.43	$120.23
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $151.36 / $223.87	Professional	TC	$131.83	$151.36	$223.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $100.00	Facility	26	$14.79	$69.18	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $295.12 / $478.63	Professional		$147.91	$295.12	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $75.86 / $131.83	Professional	26	$46.77	$75.86	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $208.93 / $346.74	Professional	TC	$97.72	$208.93	$346.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $186.21 / $234.42	Professional		$154.88	$186.21	$234.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $67.61 / $87.10	Professional	26	$54.95	$67.61	$87.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $120.23 / $151.36	Professional	TC	$97.72	$120.23	$151.36
Medcost Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $380.19 / $389.05	Professional		$316.23	$380.19	$389.05
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $112.20 / $131.83	Professional	26	$89.13	$112.20	$131.83
Medcost Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $269.15	Professional		$223.87	$223.87	$269.15
Sentara Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $229.09 / $870.96	Professional		$77.62	$229.09	$870.96
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $81.28 / $134.90	Professional	26	$61.66	$81.28	$134.90
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $194.98 / $288.40	Professional	TC	$107.15	$194.98	$288.40
United Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $239.88 / $457.09	Professional		$151.36	$239.88	$457.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $70.79 / $117.49	Professional	26	$41.69	$70.79	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $181.97 / $338.84	Professional	TC	$100.00	$181.97	$338.84