Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.82 / $155.65 / $242.81	Facility	26	$108.82	$155.65	$242.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.71 / $425.00 / $663.66	Professional		$234.71	$425.00	$663.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.12 / $118.59 / $155.65	Professional	26	$64.12	$118.59	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.24 / $299.00 / $433.05	Professional	TC	$170.24	$299.00	$433.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $214.51 / $274.31 / $453.51	Professional		$214.51	$274.31	$453.51
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.49 / $72.05 / $116.39	Professional	26	$57.49	$72.05	$116.39
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $156.43 / $200.04 / $333.94	Professional	TC	$156.43	$200.04	$333.94
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $398.88 / $409.17 / $1,548.01	Professional		$398.88	$409.17	$1,548.01
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $68.18 / $72.91 / $91.14	Professional	26	$68.18	$72.91	$91.14
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $323.12 / $336.26 / $470.76	Professional	TC	$323.12	$336.26	$470.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.95 / $72.95 / $72.95	Facility	26	$72.95	$72.95	$72.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $196.79 / $483.63 / $786.66	Professional		$196.79	$483.63	$786.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.65 / $83.02 / $141.85	Professional	26	$51.65	$83.02	$141.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $159.83 / $371.53 / $651.36	Professional	TC	$159.83	$371.53	$651.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $220.09 / $264.11 / $323.91	Professional		$220.09	$264.11	$323.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.89 / $70.28 / $85.18	Professional	26	$56.89	$70.28	$85.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $163.19 / $195.84 / $240.00	Professional	TC	$163.19	$195.84	$240.00
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $96.23 / $111.00 / $199.23	Facility	26	$96.23	$111.00	$199.23
Medcost Facility/Professional Professional Modifier Low / Median / High Price $88.06 / $356.22 / $755.00	Professional		$88.06	$356.22	$755.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $91.64 / $422.47 / $718.63	Professional		$91.64	$422.47	$718.63
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $67.95 / $89.84 / $142.10	Professional	26	$67.95	$89.84	$142.10
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $194.45 / $349.52 / $519.97	Professional	TC	$194.45	$349.52	$519.97
United Facility/Professional Professional Modifier Low / Median / High Price $210.16 / $381.15 / $790.37	Professional		$210.16	$381.15	$790.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.20 / $81.51 / $136.40	Professional	26	$50.20	$81.51	$136.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $155.60 / $295.95 / $600.23	Professional	TC	$155.60	$295.95	$600.23