Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $89.13 / $354.81	Facility	26	$48.98	$89.13	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $223.87 / $512.86	Professional		$114.82	$223.87	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $81.28 / $173.78	Professional	26	$51.29	$81.28	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $190.55 / $398.11	Professional	TC	$141.25	$190.55	$398.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $269.15 / $436.52	Professional		$199.53	$269.15	$436.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $70.79 / $112.20	Professional	26	$51.29	$70.79	$112.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $204.17 / $331.13	Professional	TC	$144.54	$204.17	$331.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $302.00 / $1,047.13	Professional		$223.87	$302.00	$1,047.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $107.15	Professional	26	$54.95	$70.79	$107.15
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $213.80 / $302.00	Professional	TC	$194.98	$213.80	$302.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $316.23 / $537.03	Professional		$173.78	$316.23	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $69.18 / $123.03	Professional	26	$42.66	$69.18	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $245.47 / $426.58	Professional	TC	$134.90	$245.47	$426.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $234.42 / $302.00	Professional		$194.98	$234.42	$302.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $61.66 / $77.62	Professional	26	$48.98	$61.66	$77.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $173.78 / $229.09	Professional	TC	$144.54	$173.78	$229.09
Medcost Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $457.09 / $478.63	Professional		$363.08	$457.09	$478.63
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $102.33 / $117.49	Professional	26	$81.28	$102.33	$117.49
Medcost Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $338.84	Professional		$223.87	$223.87	$338.84
Sentara Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $281.84 / $891.25	Professional		$70.79	$281.84	$891.25
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $74.13 / $123.03	Professional	26	$56.23	$74.13	$123.03
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $234.42 / $371.54	Professional	TC	$162.18	$234.42	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $281.84 / $467.74	Professional		$173.78	$281.84	$467.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $64.57 / $107.15	Professional	26	$37.15	$64.57	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $213.80 / $380.19	Professional	TC	$131.83	$213.80	$380.19