Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.60 / $87.02 / $199.56	Facility	26	$52.60	$87.02	$199.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.63 / $233.55 / $492.29	Professional		$180.63	$233.55	$492.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $69.23 / $127.09	Professional	26	$51.30	$69.23	$127.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.91 / $163.08 / $359.34	Professional	TC	$129.91	$163.08	$359.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.62 / $237.37 / $392.44	Professional		$185.62	$237.37	$392.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.78 / $68.55 / $104.20	Professional	26	$53.78	$68.55	$104.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $131.84 / $168.60 / $280.88	Professional	TC	$131.84	$168.60	$280.88
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $280.77 / $343.74 / $1,282.09	Professional		$280.77	$343.74	$1,282.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $68.87 / $71.54 / $90.86	Professional	26	$68.87	$71.54	$90.86
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $204.25 / $272.20 / $345.69	Professional	TC	$204.25	$272.20	$345.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.54 / $67.54 / $67.54	Facility	26	$67.54	$67.54	$67.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $170.47 / $406.38 / $637.63	Professional		$170.47	$406.38	$637.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.91 / $83.11 / $154.77	Professional	26	$48.91	$83.11	$154.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.22 / $304.01 / $504.00	Professional	TC	$134.22	$304.01	$504.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.96 / $229.15 / $281.42	Professional		$190.96	$229.15	$281.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.01 / $65.48 / $78.90	Professional	26	$53.01	$65.48	$78.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $137.96 / $165.56 / $202.89	Professional	TC	$137.96	$165.56	$202.89
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $99.69 / $114.00 / $204.48	Facility	26	$99.69	$114.00	$204.48
Medcost Facility/Professional Professional Modifier Low / Median / High Price $88.00 / $301.00 / $576.00	Professional		$88.00	$301.00	$576.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $92.50 / $378.25 / $642.01	Professional		$92.50	$378.25	$642.01
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $65.75 / $90.52 / $132.25	Professional	26	$65.75	$90.52	$132.25
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $163.72 / $304.37 / $451.44	Professional	TC	$163.72	$304.37	$451.44
United Facility/Professional Professional Modifier Low / Median / High Price $187.02 / $319.88 / $566.54	Professional		$187.02	$319.88	$566.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.73 / $82.13 / $126.77	Professional	26	$49.73	$82.13	$126.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.02 / $217.99 / $464.79	Professional	TC	$131.02	$217.99	$464.79