Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.14 / $114.03 / $218.27	Facility	26	$68.14	$114.03	$218.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $203.69 / $245.01 / $422.00	Professional		$203.69	$245.01	$422.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.17 / $80.97 / $132.63	Professional	26	$62.17	$80.97	$132.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $137.97 / $162.72 / $326.88	Professional	TC	$137.97	$162.72	$326.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.98 / $267.24 / $441.82	Professional		$208.98	$267.24	$441.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.94 / $84.67 / $133.35	Professional	26	$67.94	$84.67	$133.35
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $139.52 / $178.42 / $294.98	Professional	TC	$139.52	$178.42	$294.98
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $314.95 / $344.50 / $1,074.05	Professional		$314.95	$344.50	$1,074.05
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $75.65 / $75.65 / $98.80	Professional	26	$75.65	$75.65	$98.80
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $216.16 / $268.85 / $341.44	Professional	TC	$216.16	$268.85	$341.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.25 / $87.25 / $87.25	Facility	26	$87.25	$87.25	$87.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.38 / $386.44 / $624.55	Professional		$192.38	$386.44	$624.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.28 / $94.78 / $170.94	Professional	26	$59.28	$94.78	$170.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $142.56 / $287.68 / $468.00	Professional	TC	$142.56	$287.68	$468.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $214.17 / $257.00 / $316.97	Professional		$214.17	$257.00	$316.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.34 / $84.42 / $102.20	Professional	26	$68.34	$84.42	$102.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $145.83 / $174.99 / $214.45	Professional	TC	$145.83	$174.99	$214.45
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $103.47 / $119.00 / $239.13	Facility	26	$103.47	$119.00	$239.13
Medcost Facility/Professional Professional Modifier Low / Median / High Price $98.00 / $303.00 / $561.00	Professional		$98.00	$303.00	$561.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $99.63 / $361.68 / $646.64	Professional		$99.63	$361.68	$646.64
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $73.40 / $106.02 / $172.85	Professional	26	$73.40	$106.02	$172.85
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $166.62 / $304.37 / $440.88	Professional	TC	$166.62	$304.37	$440.88
United Facility/Professional Professional Modifier Low / Median / High Price $197.30 / $325.55 / $525.48	Professional		$197.30	$325.55	$525.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.00 / $97.44 / $144.02	Professional	26	$58.00	$97.44	$144.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.01 / $225.47 / $394.31	Professional	TC	$131.01	$225.47	$394.31