Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.41 / $91.50 / $200.21	Facility	26	$51.41	$91.50	$200.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.73 / $260.86 / $433.59	Professional		$208.73	$260.86	$433.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $61.07 / $101.59	Professional	26	$51.30	$61.07	$101.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.15 / $198.97 / $357.10	Professional	TC	$159.15	$198.97	$357.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $233.89 / $302.01 / $477.23	Professional		$233.89	$302.01	$477.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.10 / $65.22 / $101.00	Professional	26	$52.10	$65.22	$101.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $182.78 / $235.60 / $374.41	Professional	TC	$182.78	$235.60	$374.41
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $343.00 / $363.78 / $1,213.89	Professional		$343.00	$363.78	$1,213.89
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $63.79 / $74.30 / $98.87	Professional	26	$63.79	$74.30	$98.87
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $279.20 / $289.48 / $399.56	Professional	TC	$279.20	$289.48	$399.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $220.85 / $407.52 / $679.02	Professional		$220.85	$407.52	$679.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.44 / $75.54 / $139.82	Professional	26	$46.44	$75.54	$139.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.88 / $336.60 / $560.76	Professional	TC	$177.88	$336.60	$560.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.16 / $294.19 / $360.53	Professional		$245.16	$294.19	$360.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.48 / $63.60 / $77.11	Professional	26	$51.48	$63.60	$77.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $193.68 / $232.42 / $284.83	Professional	TC	$193.68	$232.42	$284.83
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $67.98 / $118.00 / $181.00	Facility	26	$67.98	$118.00	$181.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $79.73 / $320.00 / $565.00	Professional		$79.73	$320.00	$565.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $82.72 / $355.00 / $633.24	Professional		$82.72	$355.00	$633.24
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $60.76 / $81.61 / $129.22	Professional	26	$60.76	$81.61	$129.22
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $181.40 / $292.83 / $424.53	Professional	TC	$181.40	$292.83	$424.53
United Facility/Professional Professional Modifier Low / Median / High Price $219.28 / $357.94 / $581.16	Professional		$219.28	$357.94	$581.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.70 / $74.50 / $112.80	Professional	26	$44.70	$74.50	$112.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.62 / $279.86 / $467.82	Professional	TC	$169.62	$279.86	$467.82