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 $222.37 / $425.00 / $651.87	Professional		$222.37	$425.00	$651.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.12 / $118.59 / $155.65	Professional	26	$59.12	$118.59	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $164.72 / $306.97 / $416.49	Professional	TC	$164.72	$306.97	$416.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.68 / $261.74 / $432.73	Professional		$204.68	$261.74	$432.73
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 $153.04 / $195.71 / $339.90	Professional	TC	$153.04	$195.71	$339.90
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $383.47 / $390.65 / $1,543.95	Professional		$383.47	$390.65	$1,543.95
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $60.61 / $65.30 / $81.62	Professional	26	$60.61	$65.30	$81.62
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $316.13 / $325.35 / $455.49	Professional	TC	$316.13	$325.35	$455.49
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 $202.87 / $500.41 / $804.48	Professional		$202.87	$500.41	$804.48
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 $155.21 / $413.57 / $708.43	Professional	TC	$155.21	$413.57	$708.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $211.14 / $253.37 / $310.50	Professional		$211.14	$253.37	$310.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.90 / $62.87 / $76.26	Professional	26	$50.90	$62.87	$76.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $160.24 / $192.29 / $235.65	Professional	TC	$160.24	$192.29	$235.65
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $85.62 / $99.00 / $177.30	Facility	26	$85.62	$99.00	$177.30
Medcost Facility/Professional Professional Modifier Low / Median / High Price $78.81 / $432.11 / $865.00	Professional		$78.81	$432.11	$865.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $81.47 / $401.45 / $699.41	Professional		$81.47	$401.45	$699.41
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $60.47 / $80.65 / $127.70	Professional	26	$60.47	$80.65	$127.70
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $186.58 / $343.74 / $518.16	Professional	TC	$186.58	$343.74	$518.16
United Facility/Professional Professional Modifier Low / Median / High Price $198.39 / $342.80 / $682.64	Professional		$198.39	$342.80	$682.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.91 / $73.63 / $120.08	Professional	26	$44.91	$73.63	$120.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $149.30 / $297.24 / $588.46	Professional	TC	$149.30	$297.24	$588.46