Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $95.50 / $234.42	Facility	26	$51.29	$95.50	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $234.42 / $562.34	Professional		$169.82	$234.42	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $89.13 / $204.17	Professional	26	$53.70	$89.13	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $165.96 / $380.19	Professional	TC	$114.82	$165.96	$380.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $234.42 / $389.05	Professional		$169.82	$234.42	$389.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $74.13 / $120.23	Professional	26	$54.95	$74.13	$120.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $158.49 / $269.15	Professional	TC	$112.20	$158.49	$269.15
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $218.78 / $1,047.13	Professional		$67.61	$218.78	$1,047.13
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 / $213.80 / $257.04	Professional	TC	$181.97	$213.80	$257.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $93.33	Facility	26	$14.13	$66.07	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $323.59 / $524.81	Professional		$158.49	$323.59	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $72.44 / $128.82	Professional	26	$44.67	$72.44	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $245.47 / $407.38	Professional	TC	$109.65	$245.47	$407.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $199.53 / $251.19	Professional		$165.96	$199.53	$251.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $64.57 / $81.28	Professional	26	$51.29	$64.57	$81.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $134.90 / $173.78	Professional	TC	$112.20	$134.90	$173.78
Medcost Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $512.86 / $524.81	Professional		$398.11	$512.86	$524.81
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $107.15 / $125.89	Professional	26	$85.11	$107.15	$125.89
Medcost Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $288.40	Professional		$223.87	$223.87	$288.40
Sentara Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $275.42 / $1,047.13	Professional		$75.86	$275.42	$1,047.13
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $79.43 / $128.82	Professional	26	$58.88	$79.43	$128.82
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $213.80 / $371.54	Professional	TC	$123.03	$213.80	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $269.15 / $501.19	Professional		$154.88	$269.15	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $69.18 / $112.20	Professional	26	$39.81	$69.18	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $199.53 / $407.38	Professional	TC	$107.15	$199.53	$407.38