Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $89.13 / $302.00	Facility	26	$67.61	$89.13	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $257.04 / $1,000.00	Professional		$186.21	$257.04	$1,000.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $89.13 / $204.17	Professional	26	$64.57	$89.13	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $158.49 / $338.84	Professional	TC	$120.23	$158.49	$338.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $302.00 / $478.63	Professional		$213.80	$302.00	$478.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $97.72 / $154.88	Professional	26	$70.79	$97.72	$154.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $204.17 / $316.23	Professional	TC	$144.54	$204.17	$316.23
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $288.40 / $2,754.23	Professional		$93.33	$288.40	$2,754.23
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $144.54 / $158.49	Professional	26	$87.10	$144.54	$158.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $218.78 / $309.03	Professional	TC	$218.78	$218.78	$309.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $85.11 / $123.03	Facility	26	$18.62	$85.11	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $323.59 / $549.54	Professional		$190.55	$323.59	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $93.33 / $165.96	Professional	26	$57.54	$93.33	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $213.80 / $354.81	Professional	TC	$123.03	$213.80	$354.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $257.04 / $316.23	Professional		$213.80	$257.04	$316.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $83.18 / $102.33	Professional	26	$67.61	$83.18	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $173.78 / $213.80	Professional	TC	$141.25	$173.78	$213.80
Medcost Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $537.03 / $537.03	Professional		$537.03	$537.03	$537.03
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	26	$162.18	$162.18	$162.18
Medcost Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $371.54	Professional		$223.87	$223.87	$371.54
Sentara Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $257.04 / $562.34	Professional		$97.72	$257.04	$562.34
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $100.00 / $169.82	Professional	26	$77.62	$100.00	$169.82
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $208.93 / $371.54	Professional	TC	$158.49	$208.93	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $416.87 / $1,318.26	Professional		$204.17	$416.87	$1,318.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $89.13 / $158.49	Professional	26	$51.29	$89.13	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $295.12 / $1,202.26	Professional	TC	$138.04	$295.12	$1,202.26