Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $107.15 / $263.03	Facility	26	$58.88	$107.15	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $281.84 / $912.01	Professional		$181.97	$281.84	$912.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $93.33 / $234.42	Professional	26	$60.26	$93.33	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $177.83 / $426.58	Professional	TC	$120.23	$177.83	$426.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $257.04 / $436.52	Professional		$181.97	$257.04	$436.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $83.18 / $134.90	Professional	26	$61.66	$83.18	$134.90
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $169.82 / $275.42	Professional	TC	$120.23	$169.82	$275.42
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $263.03 / $1,000.00	Professional		$75.86	$263.03	$1,000.00
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $85.11 / $117.49	Professional	26	$85.11	$85.11	$117.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $177.83 / $223.87	Professional	TC	$158.49	$177.83	$223.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $74.13 / $107.15	Facility	26	$15.85	$74.13	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $309.03 / $501.19	Professional		$165.96	$309.03	$501.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $81.28 / $144.54	Professional	26	$50.12	$81.28	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $229.09 / $363.08	Professional	TC	$109.65	$229.09	$363.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $218.78 / $275.42	Professional		$177.83	$218.78	$275.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $72.44 / $93.33	Professional	26	$58.88	$72.44	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $144.54 / $186.21	Professional	TC	$117.49	$144.54	$186.21
Medcost Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $436.52 / $457.09	Professional		$363.08	$436.52	$457.09
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $120.23 / $141.25	Professional	26	$97.72	$120.23	$141.25
Medcost Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $316.23	Professional		$223.87	$223.87	$316.23
Sentara Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $275.42 / $891.25	Professional		$85.11	$275.42	$891.25
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $89.13 / $144.54	Professional	26	$67.61	$89.13	$144.54
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $234.42 / $354.81	Professional	TC	$131.83	$234.42	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $263.03 / $467.74	Professional		$162.18	$263.03	$467.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $77.62 / $128.82	Professional	26	$44.67	$77.62	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $190.55 / $363.08	Professional	TC	$104.71	$190.55	$363.08