Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.01 / $163.21 / $286.45	Facility	26	$96.01	$163.21	$286.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.26 / $179.81 / $324.70	Professional		$119.26	$179.81	$324.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.92 / $105.24 / $195.13	Professional	26	$90.92	$105.24	$195.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.75 / $42.48 / $100.62	Professional	TC	$22.75	$42.48	$100.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $130.91 / $167.42 / $276.79	Professional		$130.91	$167.42	$276.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $124.97 / $187.62	Professional	26	$97.72	$124.97	$187.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $42.44 / $70.16	Professional	TC	$32.79	$42.44	$70.16
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $151.35 / $295.13 / $2,069.58	Professional		$151.35	$295.13	$2,069.58
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $111.90 / $120.06 / $120.06	Professional	26	$111.90	$120.06	$120.06
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $31.29 / $31.29 / $61.02	Professional	TC	$31.29	$31.29	$61.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $121.50 / $121.50 / $121.50	Facility	26	$121.50	$121.50	$121.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.57 / $225.93 / $610.99	Professional		$128.57	$225.93	$610.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.49 / $140.97 / $265.76	Professional	26	$92.49	$140.97	$265.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.55 / $58.47 / $507.36	Professional	TC	$31.55	$58.47	$507.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.19 / $191.24 / $200.89	Professional		$144.19	$191.24	$200.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $105.78 / $138.72 / $153.03	Professional	26	$105.78	$138.72	$153.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.42 / $53.67 / $54.89	Professional	TC	$38.42	$53.67	$54.89
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $124.11 / $202.00 / $317.45	Facility	26	$124.11	$202.00	$317.45
Medcost Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $172.00 / $340.00	Professional		$49.00	$172.00	$340.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $57.72 / $203.62 / $3,372.00	Professional		$57.72	$203.62	$3,372.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $106.82 / $154.60 / $234.18	Professional	26	$106.82	$154.60	$234.18
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $33.43 / $57.17 / $210.44	Professional	TC	$33.43	$57.17	$210.44
United Facility/Professional Professional Modifier Low / Median / High Price $123.69 / $201.00 / $655.51	Professional		$123.69	$201.00	$655.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.14 / $132.69 / $219.24	Professional	26	$88.14	$132.69	$219.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.81 / $45.00 / $497.85	Professional	TC	$23.81	$45.00	$497.85