Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.71 / $96.67 / $231.05	Facility	26	$88.71	$96.67	$231.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $310.81 / $344.71 / $616.73	Professional		$310.81	$344.71	$616.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.15 / $96.67 / $172.80	Professional	26	$86.15	$96.67	$172.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.14 / $256.00 / $435.19	Professional	TC	$214.14	$256.00	$435.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $273.66 / $354.09 / $485.63	Professional		$273.66	$354.09	$485.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.20 / $97.46 / $133.66	Professional	26	$76.20	$97.46	$133.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $198.34 / $256.63 / $351.96	Professional	TC	$198.34	$256.63	$351.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $367.16 / $573.38 / $2,413.00	Professional		$367.16	$573.38	$2,413.00
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $95.13 / $110.91 / $193.11	Professional	26	$95.13	$110.91	$193.11
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $272.04 / $335.06 / $583.36	Professional	TC	$272.04	$335.06	$583.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $271.08 / $410.77 / $723.34	Professional		$271.08	$410.77	$723.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.25 / $117.04 / $209.80	Professional	26	$85.25	$117.04	$209.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $189.72 / $299.23 / $509.47	Professional	TC	$189.72	$299.23	$509.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $264.48 / $317.38 / $391.49	Professional		$264.48	$317.38	$391.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $79.38 / $95.26 / $117.48	Professional	26	$79.38	$95.26	$117.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $185.10 / $224.39 / $280.49	Professional	TC	$185.10	$224.39	$280.49
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $115.99 / $135.94 / $175.70	Facility	26	$115.99	$135.94	$175.70
Medcost Facility/Professional Professional Modifier Low / Median / High Price $111.00 / $309.00 / $533.00	Professional		$111.00	$309.00	$533.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $114.76 / $349.09 / $782.00	Professional		$114.76	$349.09	$782.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $90.05 / $115.16 / $193.61	Professional	26	$90.05	$115.16	$193.61
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $215.87 / $291.16 / $495.18	Professional	TC	$215.87	$291.16	$495.18
United Facility/Professional Professional Modifier Low / Median / High Price $264.26 / $426.67 / $645.71	Professional		$264.26	$426.67	$645.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.55 / $124.92 / $188.40	Professional	26	$72.55	$124.92	$188.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.57 / $293.97 / $441.83	Professional	TC	$177.57	$293.97	$441.83