Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $128.82 / $316.23	Facility	26	$53.70	$128.82	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $134.90 / $363.08	Professional		$107.15	$134.90	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $66.07 / $151.36	Professional	26	$53.70	$66.07	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $63.10 / $141.25	Professional	TC	$52.48	$63.10	$141.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $158.49 / $239.88	Professional		$114.82	$158.49	$239.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.43 / $114.82	Professional	26	$56.23	$79.43	$114.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $83.18 / $123.03	Professional	TC	$57.54	$83.18	$123.03
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $128.82 / $676.08	Professional		$56.23	$128.82	$676.08
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $61.66 / $75.86	Professional	26	$58.88	$61.66	$75.86
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $67.61 / $102.33	Professional	TC	$60.26	$67.61	$102.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $186.21 / $302.00	Professional		$117.49	$186.21	$302.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $79.43 / $131.83	Professional	26	$58.88	$79.43	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $104.71 / $190.55	Professional	TC	$57.54	$104.71	$190.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $138.04 / $169.82	Professional		$109.65	$138.04	$169.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $64.57 / $83.18	Professional	26	$52.48	$64.57	$83.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $72.44 / $89.13	Professional	TC	$57.54	$72.44	$89.13
Medcost Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $239.88 / $331.13	Professional		$194.98	$239.88	$331.13
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $97.72 / $109.65	Professional	26	$77.62	$97.72	$109.65
Medcost Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $239.88	Professional		$239.88	$239.88	$239.88
Sentara Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $141.25 / $323.59	Professional		$67.61	$141.25	$323.59
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $83.18 / $128.82	Professional	26	$63.10	$83.18	$128.82
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $89.13 / $177.83	Professional	TC	$61.66	$89.13	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $165.96 / $281.84	Professional		$107.15	$165.96	$281.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $123.03	Professional	26	$50.12	$70.79	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $95.50 / $177.83	Professional	TC	$53.70	$95.50	$177.83