Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $100.00 / $389.05	Facility	26	$52.48	$100.00	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $263.03 / $588.84	Professional		$186.21	$263.03	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $67.61 / $134.90	Professional	26	$52.48	$67.61	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $190.55 / $371.54	Professional	TC	$131.83	$190.55	$371.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $275.42 / $457.09	Professional		$194.98	$275.42	$457.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $77.62 / $123.03	Professional	26	$56.23	$77.62	$123.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $199.53 / $331.13	Professional	TC	$138.04	$199.53	$331.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $281.84 / $1,288.25	Professional		$70.79	$281.84	$1,288.25
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $87.10 / $120.23	Professional	26	$54.95	$87.10	$120.23
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $204.17 / $309.03	Professional	TC	$186.21	$204.17	$309.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $97.72	Facility	26	$14.45	$67.61	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $380.19 / $645.65	Professional		$186.21	$380.19	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $75.86 / $134.90	Professional	26	$46.77	$75.86	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $302.00 / $501.19	Professional	TC	$134.90	$302.00	$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 / $85.11	Professional	26	$53.70	$66.07	$85.11
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 / $616.60 / $630.96	Professional		$467.74	$616.60	$630.96
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $112.20 / $128.82	Professional	26	$89.13	$112.20	$128.82
Medcost Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $338.84	Professional		$275.42	$275.42	$338.84
Sentara Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $316.23 / $1,023.29	Professional		$77.62	$316.23	$1,023.29
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $81.28 / $134.90	Professional	26	$61.66	$81.28	$134.90
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $263.03 / $457.09	Professional	TC	$151.36	$263.03	$457.09
United Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $316.23 / $616.60	Professional		$181.97	$316.23	$616.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $70.79 / $117.49	Professional	26	$40.74	$70.79	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $245.47 / $512.86	Professional	TC	$131.83	$245.47	$512.86