Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $123.03 / $309.03	Facility	26	$67.61	$123.03	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $302.00 / $724.44	Professional		$213.80	$302.00	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $100.00 / $218.78	Professional	26	$64.57	$100.00	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $199.53 / $457.09	Professional	TC	$141.25	$199.53	$457.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $309.03 / $478.63	Professional		$218.78	$309.03	$478.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $95.50 / $158.49	Professional	26	$70.79	$95.50	$158.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $204.17 / $338.84	Professional	TC	$144.54	$204.17	$338.84
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $316.23 / $1,096.48	Professional		$151.36	$316.23	$1,096.48
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $97.72 / $138.04	Professional	26	$89.13	$97.72	$138.04
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $223.87 / $309.03	Professional	TC	$213.80	$223.87	$309.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $87.10 / $123.03	Facility	26	$18.62	$87.10	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $380.19 / $630.96	Professional		$204.17	$380.19	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $91.20 / $165.96	Professional	26	$58.88	$91.20	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $281.84 / $467.74	Professional	TC	$134.90	$281.84	$467.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $257.04 / $331.13	Professional		$213.80	$257.04	$331.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $85.11 / $107.15	Professional	26	$67.61	$85.11	$107.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $173.78 / $229.09	Professional	TC	$144.54	$173.78	$229.09
Medcost Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $524.81 / $549.54	Professional		$436.52	$524.81	$549.54
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $125.89 / $165.96	Professional	26	$102.33	$125.89	$165.96
Medcost Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $380.19	Professional		$275.42	$275.42	$380.19
Sentara Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $331.13 / $912.01	Professional		$95.50	$331.13	$912.01
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $95.50 / $158.49	Professional	26	$72.44	$95.50	$158.49
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $295.12 / $446.68	Professional	TC	$158.49	$295.12	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $323.59 / $562.34	Professional		$194.98	$323.59	$562.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $83.18 / $144.54	Professional	26	$50.12	$83.18	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $229.09 / $446.68	Professional	TC	$128.82	$229.09	$446.68