Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.03 / $87.27 / $157.50	Facility	26	$49.03	$87.27	$157.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.15 / $234.53 / $422.00	Professional		$206.15	$234.53	$422.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.03 / $59.38 / $115.20	Professional	26	$49.03	$59.38	$115.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.85 / $175.16 / $305.14	Professional	TC	$158.85	$175.16	$305.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $216.66 / $270.97 / $434.16	Professional		$216.66	$270.97	$434.16
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.09 / $62.65 / $96.21	Professional	26	$50.09	$62.65	$96.21
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $166.57 / $209.30 / $333.78	Professional	TC	$166.57	$209.30	$333.78
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $266.92 / $329.35 / $1,004.97	Professional		$266.92	$329.35	$1,004.97
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $60.83 / $71.26 / $84.04	Professional	26	$60.83	$71.26	$84.04
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $206.09 / $232.25 / $264.92	Professional	TC	$206.09	$232.25	$264.92
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $195.99 / $350.02 / $598.83	Professional		$195.99	$350.02	$598.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.56 / $72.40 / $133.09	Professional	26	$44.56	$72.40	$133.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $155.34 / $279.86 / $463.14	Professional	TC	$155.34	$279.86	$463.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $221.78 / $266.14 / $326.14	Professional		$221.78	$266.14	$326.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $60.63 / $73.55	Professional	26	$49.08	$60.63	$73.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $172.70 / $207.24 / $253.98	Professional	TC	$172.70	$207.24	$253.98
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $75.01 / $123.00 / $187.00	Facility	26	$75.01	$123.00	$187.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $74.00 / $278.00 / $486.00	Professional		$74.00	$278.00	$486.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $79.02 / $321.88 / $575.76	Professional		$79.02	$321.88	$575.76
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $58.60 / $77.78 / $123.16	Professional	26	$58.60	$77.78	$123.16
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $178.37 / $269.52 / $418.77	Professional	TC	$178.37	$269.52	$418.77
United Facility/Professional Professional Modifier Low / Median / High Price $194.99 / $316.86 / $491.54	Professional		$194.99	$316.86	$491.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.99 / $70.65 / $117.09	Professional	26	$43.99	$70.65	$117.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.88 / $238.89 / $376.33	Professional	TC	$147.88	$238.89	$376.33