Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $95.50 / $234.42	Facility	26	$53.70	$95.50	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $154.88 / $870.96	Professional		$104.71	$154.88	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $128.82 / $851.14	Professional	26	$53.70	$128.82	$851.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $83.18 / $199.53	Professional	TC	$53.70	$83.18	$199.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $177.83 / $309.03	Professional		$123.03	$177.83	$309.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $83.18 / $138.04	Professional	26	$58.88	$83.18	$138.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $93.33 / $162.18	Professional	TC	$64.57	$93.33	$162.18
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $147.91 / $691.83	Professional		$64.57	$147.91	$691.83
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $66.07 / $100.00	Professional	26	$58.88	$66.07	$100.00
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $95.50 / $141.25	Professional	TC	$75.86	$95.50	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $190.55 / $338.84	Professional		$107.15	$190.55	$338.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $144.54	Professional	26	$52.48	$81.28	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $107.15 / $186.21	Professional	TC	$58.88	$107.15	$186.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $169.82 / $181.97	Professional		$125.89	$169.82	$181.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $79.43 / $89.13	Professional	26	$60.26	$79.43	$89.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $89.13 / $97.72	Professional	TC	$67.61	$89.13	$97.72
Medcost Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $269.15 / $302.00	Professional		$239.88	$269.15	$302.00
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $95.50 / $123.03	Professional	26	$87.10	$95.50	$123.03
Medcost Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Professional		$199.53	$199.53	$199.53
Sentara Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $169.82 / $3,090.30	Professional		$70.79	$169.82	$3,090.30
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $81.28 / $144.54	Professional	26	$60.26	$81.28	$144.54
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $104.71 / $177.83	Professional	TC	$70.79	$104.71	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $177.83 / $288.40	Professional		$109.65	$177.83	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $74.13 / $123.03	Professional	26	$50.12	$74.13	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $102.33 / $177.83	Professional	TC	$58.88	$102.33	$177.83