Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $125.89 / $302.00	Facility	26	$74.13	$125.89	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $354.81 / $1,122.02	Professional		$239.88	$354.81	$1,122.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $95.50 / $251.19	Professional	26	$74.13	$95.50	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $218.78 / $524.81	Professional	TC	$162.18	$218.78	$524.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $380.19 / $602.56	Professional		$269.15	$380.19	$602.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $104.71 / $169.82	Professional	26	$77.62	$104.71	$169.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $269.15 / $426.58	Professional	TC	$190.55	$269.15	$426.58
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $407.38 / $1,819.70	Professional		$323.59	$407.38	$1,819.70
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $107.15 / $151.36	Professional	26	$83.18	$107.15	$151.36
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $288.40 / $363.08	Professional	TC	$257.04	$288.40	$363.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $134.90	Facility	26	$19.95	$93.33	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $489.78 / $831.76	Professional		$245.47	$489.78	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $104.71 / $186.21	Professional	26	$64.57	$104.71	$186.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $380.19 / $676.08	Professional	TC	$173.78	$380.19	$676.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $323.59 / $416.87	Professional		$269.15	$323.59	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $91.20 / $117.49	Professional	26	$74.13	$91.20	$117.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $234.42 / $302.00	Professional	TC	$190.55	$234.42	$302.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $758.58 / $776.25	Professional		$630.96	$758.58	$776.25
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $154.88 / $177.83	Professional	26	$123.03	$154.88	$177.83
Medcost Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $416.87	Professional		$275.42	$275.42	$416.87
Sentara Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $380.19 / $1,479.11	Professional		$107.15	$380.19	$1,479.11
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $112.20 / $186.21	Professional	26	$85.11	$112.20	$186.21
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $338.84 / $512.86	Professional	TC	$177.83	$338.84	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $389.05 / $831.76	Professional		$234.42	$389.05	$831.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $97.72 / $162.18	Professional	26	$56.23	$97.72	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $309.03 / $707.95	Professional	TC	$169.82	$309.03	$707.95