Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $114.82 / $181.97	Facility	26	$97.72	$114.82	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $204.17 / $457.09	Professional		$162.18	$204.17	$457.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $114.82 / $263.03	Professional	26	$93.33	$114.82	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $81.28 / $134.90	Professional	TC	$67.61	$81.28	$134.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $223.87 / $416.87	Professional		$162.18	$223.87	$416.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $131.83 / $245.47	Professional	26	$95.50	$131.83	$245.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $93.33 / $169.82	Professional	TC	$69.18	$93.33	$169.82
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $173.78 / $251.19	Professional		$87.10	$173.78	$251.19
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $95.50 / $134.90	Professional	26	$95.50	$95.50	$134.90
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $77.62 / $91.20	Professional	TC	$69.18	$77.62	$91.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $251.19 / $389.05	Professional		$169.82	$251.19	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $141.25 / $223.87	Professional	26	$100.00	$141.25	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $104.71 / $165.96	Professional	TC	$70.79	$104.71	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $208.93 / $269.15	Professional		$165.96	$208.93	$269.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $117.49 / $151.36	Professional	26	$93.33	$117.49	$151.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $93.33 / $114.82	Professional	TC	$74.13	$93.33	$114.82
Medcost Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $354.81 / $354.81	Professional		$354.81	$354.81	$354.81
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $194.98 / $194.98	Professional	26	$194.98	$194.98	$194.98
Medcost Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $186.21 / $186.21	Professional		$186.21	$186.21	$186.21
Sentara Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $190.55 / $398.11	Professional		$93.33	$190.55	$398.11
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $138.04 / $229.09	Professional	26	$102.33	$138.04	$229.09
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $104.71 / $173.78	Professional	TC	$75.86	$104.71	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $245.47 / $389.05	Professional		$158.49	$245.47	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $138.04 / $223.87	Professional	26	$89.13	$138.04	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $109.65 / $173.78	Professional	TC	$69.18	$109.65	$173.78