Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.46 / $128.72 / $211.09	Facility	26	$94.46	$128.72	$211.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $236.73 / $461.97 / $665.79	Professional		$236.73	$461.97	$665.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.39 / $118.59 / $166.02	Professional	26	$60.39	$118.59	$166.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $176.35 / $335.00 / $483.88	Professional	TC	$176.35	$335.00	$483.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.37 / $261.35 / $432.08	Professional		$204.37	$261.35	$432.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.62 / $64.54 / $100.81	Professional	26	$51.62	$64.54	$100.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $152.74 / $195.32 / $339.90	Professional	TC	$152.74	$195.32	$339.90
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $382.83 / $443.39 / $1,545.14	Professional		$382.83	$443.39	$1,545.14
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $62.67 / $67.34 / $124.57	Professional	26	$62.67	$67.34	$124.57
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $315.49 / $378.09 / $530.97	Professional	TC	$315.49	$378.09	$530.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.84 / $64.84 / $64.84	Facility	26	$64.84	$64.84	$64.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.56 / $500.76 / $806.45	Professional		$202.56	$500.76	$806.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.91 / $74.64 / $140.72	Professional	26	$45.91	$74.64	$140.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.90 / $412.75 / $709.71	Professional	TC	$154.90	$412.75	$709.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $210.49 / $252.58 / $309.54	Professional		$210.49	$252.58	$309.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.58 / $62.48 / $76.26	Professional	26	$50.58	$62.48	$76.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $159.91 / $191.90 / $235.18	Professional	TC	$159.91	$191.90	$235.18
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $86.39 / $116.00 / $177.30	Facility	26	$86.39	$116.00	$177.30
Medcost Facility/Professional Professional Modifier Low / Median / High Price $78.81 / $429.84 / $868.00	Professional		$78.81	$429.84	$868.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $400.50 / $705.43	Professional		$81.28	$400.50	$705.43
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $60.75 / $80.17 / $126.94	Professional	26	$60.75	$80.17	$126.94
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $185.87 / $345.09 / $524.85	Professional	TC	$185.87	$345.09	$524.85
United Facility/Professional Professional Modifier Low / Median / High Price $197.53 / $354.63 / $719.82	Professional		$197.53	$354.63	$719.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.63 / $67.78 / $116.30	Professional	26	$44.63	$67.78	$116.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.72 / $298.06 / $607.96	Professional	TC	$148.72	$298.06	$607.96