Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $87.10 / $263.03	Facility	26	$52.48	$87.10	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $275.42 / $676.08	Professional		$190.55	$275.42	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $81.28 / $194.98	Professional	26	$53.70	$81.28	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $190.55 / $457.09	Professional	TC	$131.83	$190.55	$457.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $275.42 / $446.68	Professional		$194.98	$275.42	$446.68
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $75.86 / $123.03	Professional	26	$57.54	$75.86	$123.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $194.98 / $323.59	Professional	TC	$138.04	$194.98	$323.59
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $281.84 / $1,288.25	Professional		$69.18	$281.84	$1,288.25
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $75.86 / $107.15	Professional	26	$75.86	$75.86	$107.15
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $204.17 / $309.03	Professional	TC	$181.97	$204.17	$309.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $380.19 / $645.65	Professional		$190.55	$380.19	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $79.43 / $141.25	Professional	26	$47.86	$79.43	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $295.12 / $501.19	Professional	TC	$134.90	$295.12	$501.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $229.09 / $295.12	Professional		$190.55	$229.09	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $66.07 / $83.18	Professional	26	$53.70	$66.07	$83.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $165.96 / $213.80	Professional	TC	$134.90	$165.96	$213.80
Medcost Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $630.96 / $645.65	Professional		$467.74	$630.96	$645.65
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $120.23 / $128.82	Professional	26	$97.72	$120.23	$128.82
Medcost Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $331.13	Professional		$275.42	$275.42	$331.13
Sentara Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $331.13 / $1,202.26	Professional		$85.11	$331.13	$1,202.26
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $83.18 / $131.83	Professional	26	$60.26	$83.18	$131.83
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $302.00 / $457.09	Professional	TC	$151.36	$302.00	$457.09
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $316.23 / $616.60	Professional		$186.21	$316.23	$616.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $77.62 / $125.89	Professional	26	$44.67	$77.62	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $245.47 / $501.19	Professional	TC	$128.82	$245.47	$501.19