Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.89 / $93.54 / $200.21	Facility	26	$61.89	$93.54	$200.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $179.49 / $260.86 / $422.00	Professional		$179.49	$260.86	$422.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.08 / $60.72 / $99.77	Professional	26	$51.08	$60.72	$99.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $130.21 / $198.97 / $337.38	Professional	TC	$130.21	$198.97	$337.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $184.70 / $236.19 / $390.49	Professional		$184.70	$236.19	$390.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.24 / $65.33 / $101.00	Professional	26	$52.24	$65.33	$101.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $132.44 / $169.38 / $282.18	Professional	TC	$132.44	$169.38	$282.18
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $279.50 / $303.07 / $1,084.39	Professional		$279.50	$303.07	$1,084.39
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $63.79 / $74.30 / $99.05	Professional	26	$63.79	$74.30	$99.05
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $205.20 / $223.84 / $313.38	Professional	TC	$205.20	$223.84	$313.38
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 $169.57 / $376.67 / $620.98	Professional		$169.57	$376.67	$620.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.44 / $75.37 / $136.47	Professional	26	$46.44	$75.37	$136.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.53 / $297.55 / $476.48	Professional	TC	$134.53	$297.55	$476.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.10 / $228.12 / $280.10	Professional		$190.10	$228.12	$280.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.15 / $63.19 / $76.62	Professional	26	$51.15	$63.19	$76.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $138.94 / $166.74 / $204.34	Professional	TC	$138.94	$166.74	$204.34
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $80.00 / $87.93 / $181.47	Facility	26	$80.00	$87.93	$181.47
Medcost Facility/Professional Professional Modifier Low / Median / High Price $79.28 / $313.00 / $574.00	Professional		$79.28	$313.00	$574.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $82.46 / $341.20 / $605.29	Professional		$82.46	$341.20	$605.29
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $60.82 / $81.13 / $128.47	Professional	26	$60.82	$81.13	$128.47
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $169.87 / $280.27 / $413.11	Professional	TC	$169.87	$280.27	$413.11
United Facility/Professional Professional Modifier Low / Median / High Price $187.83 / $316.50 / $548.51	Professional		$187.83	$316.50	$548.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.29 / $74.06 / $112.49	Professional	26	$46.29	$74.06	$112.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.44 / $230.36 / $426.62	Professional	TC	$138.44	$230.36	$426.62