Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $138.04 / $346.74	Facility	26	$77.62	$138.04	$346.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $346.74 / $1,202.26	Professional		$239.88	$346.74	$1,202.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $93.33 / $288.40	Professional	26	$77.62	$93.33	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $218.78 / $549.54	Professional	TC	$158.49	$218.78	$549.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $389.05 / $645.65	Professional		$275.42	$389.05	$645.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $107.15 / $177.83	Professional	26	$79.43	$107.15	$177.83
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 $125.89 / $398.11 / $1,737.80	Professional		$125.89	$398.11	$1,737.80
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $112.20 / $169.82	Professional	26	$100.00	$112.20	$169.82
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $288.40 / $446.68	Professional	TC	$263.03	$288.40	$446.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $141.25	Facility	26	$20.89	$97.72	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $489.78 / $812.83	Professional		$251.19	$489.78	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $109.65 / $194.98	Professional	26	$67.61	$109.65	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $354.81 / $630.96	Professional	TC	$173.78	$354.81	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $331.13 / $416.87	Professional		$275.42	$331.13	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $95.50 / $120.23	Professional	26	$77.62	$95.50	$120.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $234.42 / $302.00	Professional	TC	$194.98	$234.42	$302.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $870.96 / $870.96	Professional		$660.69	$870.96	$870.96
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $169.82 / $186.21	Professional	26	$134.90	$169.82	$186.21
Medcost Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $426.58	Professional		$239.88	$239.88	$426.58
Sentara Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $380.19 / $1,513.56	Professional		$112.20	$380.19	$1,513.56
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $117.49 / $194.98	Professional	26	$89.13	$117.49	$194.98
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $338.84 / $524.81	Professional	TC	$177.83	$338.84	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $407.38 / $794.33	Professional		$239.88	$407.38	$794.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $102.33 / $173.78	Professional	26	$57.54	$102.33	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $288.40 / $645.65	Professional	TC	$169.82	$288.40	$645.65