Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.50 / $95.23 / $230.40	Facility	26	$53.50	$95.23	$230.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.09 / $272.64 / $492.52	Professional		$194.09	$272.64	$492.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.64 / $62.29 / $120.02	Professional	26	$51.64	$62.29	$120.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.44 / $198.94 / $372.52	Professional	TC	$142.44	$198.94	$372.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.45 / $255.06 / $421.69	Professional		$199.45	$255.06	$421.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.70 / $69.95 / $107.08	Professional	26	$54.70	$69.95	$107.08
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.74 / $185.10 / $306.02	Professional	TC	$144.74	$185.10	$306.02
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $302.08 / $322.69 / $1,075.21	Professional		$302.08	$322.69	$1,075.21
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $70.06 / $75.23 / $95.55	Professional	26	$70.06	$75.23	$95.55
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $224.24 / $247.45 / $346.43	Professional	TC	$224.24	$247.45	$346.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $183.01 / $400.00 / $659.72	Professional		$183.01	$400.00	$659.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.75 / $85.28 / $151.94	Professional	26	$49.75	$85.28	$151.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.33 / $307.41 / $497.46	Professional	TC	$148.33	$307.41	$497.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.65 / $245.59 / $301.22	Professional		$204.65	$245.59	$301.22
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.58 / $66.19 / $80.26	Professional	26	$53.58	$66.19	$80.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $151.07 / $181.28 / $222.16	Professional	TC	$151.07	$181.28	$222.16
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $102.69 / $119.00 / $214.05	Facility	26	$102.69	$119.00	$214.05
Medcost Facility/Professional Professional Modifier Low / Median / High Price $92.00 / $336.00 / $615.00	Professional		$92.00	$336.00	$615.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $96.11 / $357.54 / $662.73	Professional		$96.11	$357.54	$662.73
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $66.84 / $91.54 / $141.72	Professional	26	$66.84	$91.54	$141.72
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $180.51 / $299.81 / $436.13	Professional	TC	$180.51	$299.81	$436.13
United Facility/Professional Professional Modifier Low / Median / High Price $199.55 / $340.71 / $578.32	Professional		$199.55	$340.71	$578.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.46 / $77.09 / $121.97	Professional	26	$49.46	$77.09	$121.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.16 / $262.54 / $470.95	Professional	TC	$148.16	$262.54	$470.95