Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.83 / $97.85 / $209.49	Facility	26	$53.83	$97.85	$209.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.15 / $263.70 / $406.55	Professional		$182.15	$263.70	$406.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.94 / $60.93 / $92.60	Professional	26	$51.94	$60.93	$92.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $130.21 / $198.97 / $313.95	Professional	TC	$130.21	$198.97	$313.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $187.16 / $239.81 / $395.70	Professional		$187.16	$239.81	$395.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.20 / $67.98 / $105.82	Professional	26	$54.20	$67.98	$105.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $132.44 / $171.84 / $281.52	Professional	TC	$132.44	$171.84	$281.52
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $283.02 / $339.83 / $1,267.32	Professional		$283.02	$339.83	$1,267.32
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $65.98 / $65.98 / $83.79	Professional	26	$65.98	$65.98	$83.79
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $205.20 / $273.85 / $347.79	Professional	TC	$205.20	$273.85	$347.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $171.90 / $400.77 / $627.89	Professional		$171.90	$400.77	$627.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.65 / $79.02 / $146.38	Professional	26	$48.65	$79.02	$146.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $135.30 / $316.60 / $504.00	Professional	TC	$135.30	$316.60	$504.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $191.55 / $229.86 / $282.38	Professional		$191.55	$229.86	$282.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.58 / $66.19 / $80.75	Professional	26	$53.58	$66.19	$80.75
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 $91.04 / $105.00 / $218.93	Facility	26	$91.04	$105.00	$218.93
Medcost Facility/Professional Professional Modifier Low / Median / High Price $83.39 / $307.00 / $569.00	Professional		$83.39	$307.00	$569.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $86.25 / $341.93 / $607.95	Professional		$86.25	$341.93	$607.95
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $63.45 / $84.68 / $133.77	Professional	26	$63.45	$84.68	$133.77
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $166.59 / $264.99 / $424.35	Professional	TC	$166.59	$264.99	$424.35
United Facility/Professional Professional Modifier Low / Median / High Price $184.70 / $316.79 / $558.59	Professional		$184.70	$316.79	$558.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.38 / $77.09 / $116.34	Professional	26	$47.38	$77.09	$116.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $133.30 / $253.56 / $466.05	Professional	TC	$133.30	$253.56	$466.05