Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.83 / $130.61 / $277.76	Facility	26	$76.83	$130.61	$277.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $236.51 / $291.61 / $536.29	Professional		$236.51	$291.61	$536.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.15 / $92.67 / $183.08	Professional	26	$74.15	$92.67	$183.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.91 / $198.94 / $380.41	Professional	TC	$158.91	$198.94	$380.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $261.36 / $340.34 / $533.30	Professional		$261.36	$340.34	$533.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.38 / $95.58 / $150.44	Professional	26	$77.38	$95.58	$150.44
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $183.69 / $240.12 / $367.57	Professional	TC	$183.69	$240.12	$367.57
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $402.40 / $420.50 / $1,569.37	Professional		$402.40	$420.50	$1,569.37
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $100.11 / $100.11 / $127.14	Professional	26	$100.11	$100.11	$127.14
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $290.89 / $320.39 / $481.64	Professional	TC	$290.89	$320.39	$481.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.41 / $98.41 / $98.41	Facility	26	$98.41	$98.41	$98.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $253.22 / $517.00 / $793.57	Professional		$253.22	$517.00	$793.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.69 / $114.20 / $196.59	Professional	26	$69.69	$114.20	$196.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $184.78 / $384.03 / $631.40	Professional	TC	$184.78	$384.03	$631.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $274.69 / $329.62 / $404.79	Professional		$274.69	$329.62	$404.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.41 / $95.62 / $115.25	Professional	26	$77.41	$95.62	$115.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $197.28 / $236.73 / $290.11	Professional	TC	$197.28	$236.73	$290.11
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $100.68 / $157.00 / $285.99	Facility	26	$100.68	$157.00	$285.99
Medcost Facility/Professional Professional Modifier Low / Median / High Price $119.07 / $369.00 / $744.00	Professional		$119.07	$369.00	$744.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $127.28 / $440.51 / $754.21	Professional		$127.28	$440.51	$754.21
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $91.70 / $127.36 / $193.34	Professional	26	$91.70	$127.36	$193.34
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $181.37 / $335.57 / $525.12	Professional	TC	$181.37	$335.57	$525.12
United Facility/Professional Professional Modifier Low / Median / High Price $244.26 / $396.92 / $781.17	Professional		$244.26	$396.92	$781.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.30 / $111.10 / $167.60	Professional	26	$68.30	$111.10	$167.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $170.19 / $287.55 / $642.23	Professional	TC	$170.19	$287.55	$642.23