Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $91.20 / $223.87	Facility	26	$50.12	$91.20	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $199.53 / $616.60	Professional		$134.90	$199.53	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $91.20 / $181.97	Professional	26	$52.48	$91.20	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $114.82 / $309.03	Professional	TC	$79.43	$114.82	$309.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $190.55 / $309.03	Professional		$134.90	$190.55	$309.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $114.82	Professional	26	$52.48	$72.44	$114.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $114.82 / $194.98	Professional	TC	$81.28	$114.82	$194.98
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $194.98 / $954.99	Professional		$72.44	$194.98	$954.99
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $66.07 / $112.20	Professional	26	$56.23	$66.07	$112.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $120.23 / $181.97	Professional	TC	$109.65	$120.23	$181.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $64.57 / $91.20	Facility	26	$13.80	$64.57	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $257.04 / $416.87	Professional		$120.23	$257.04	$416.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $70.79 / $123.03	Professional	26	$43.65	$70.79	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $165.96 / $302.00	Professional	TC	$74.13	$165.96	$302.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $162.18 / $199.53	Professional		$131.83	$162.18	$199.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $63.10 / $79.43	Professional	26	$50.12	$63.10	$79.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $97.72 / $125.89	Professional	TC	$79.43	$97.72	$125.89
Medcost Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $426.58 / $436.52	Professional		$316.23	$426.58	$436.52
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $104.71 / $123.03	Professional	26	$83.18	$104.71	$123.03
Medcost Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $229.09	Professional		$223.87	$223.87	$229.09
Sentara Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $208.93 / $954.99	Professional		$72.44	$208.93	$954.99
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $75.86 / $125.89	Professional	26	$57.54	$75.86	$125.89
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $165.96 / $269.15	Professional	TC	$89.13	$165.96	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $204.17 / $398.11	Professional		$120.23	$204.17	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $67.61 / $117.49	Professional	26	$38.90	$67.61	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $125.89 / $309.03	Professional	TC	$72.44	$125.89	$309.03