Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $107.15 / $269.15	Facility	26	$58.88	$107.15	$269.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $309.03 / $933.25	Professional		$223.87	$309.03	$933.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $93.33 / $199.53	Professional	26	$61.66	$93.33	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $218.78 / $537.03	Professional	TC	$158.49	$218.78	$537.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $363.08 / $602.56	Professional		$257.04	$363.08	$602.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $85.11 / $134.90	Professional	26	$63.10	$85.11	$134.90
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $269.15 / $426.58	Professional	TC	$190.55	$269.15	$426.58
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $363.08 / $1,258.93	Professional		$77.62	$363.08	$1,258.93
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $95.50 / $128.82	Professional	26	$67.61	$95.50	$128.82
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $288.40 / $407.38	Professional	TC	$263.03	$288.40	$407.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $75.86 / $107.15	Facility	26	$16.22	$75.86	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $416.87 / $707.95	Professional		$229.09	$416.87	$707.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $83.18 / $147.91	Professional	26	$51.29	$83.18	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $338.84 / $562.34	Professional	TC	$169.82	$338.84	$562.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $309.03 / $398.11	Professional		$257.04	$309.03	$398.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $72.44 / $93.33	Professional	26	$58.88	$72.44	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $234.42 / $309.03	Professional	TC	$190.55	$234.42	$309.03
Medcost Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $616.60 / $630.96	Professional		$501.19	$616.60	$630.96
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $123.03 / $144.54	Professional	26	$97.72	$123.03	$144.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $398.11	Professional		$275.42	$275.42	$398.11
Sentara Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $363.08 / $977.24	Professional		$85.11	$363.08	$977.24
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $89.13 / $147.91	Professional	26	$67.61	$89.13	$147.91
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $323.59 / $501.19	Professional	TC	$177.83	$323.59	$501.19
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $363.08 / $660.69	Professional		$223.87	$363.08	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $79.43 / $128.82	Professional	26	$45.71	$79.43	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $275.42 / $549.54	Professional	TC	$165.96	$275.42	$549.54