Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.60 / $155.65 / $240.62	Facility	26	$91.60	$155.65	$240.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.49 / $445.01 / $680.00	Professional		$216.49	$445.01	$680.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.67 / $121.81 / $188.60	Professional	26	$70.67	$121.81	$188.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.74 / $335.00 / $478.39	Professional	TC	$142.74	$335.00	$478.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.62 / $237.37 / $402.81	Professional		$185.62	$237.37	$402.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.00 / $78.18 / $123.52	Professional	26	$63.00	$78.18	$123.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $122.62 / $156.81 / $318.85	Professional	TC	$122.62	$156.81	$318.85
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $335.47 / $341.52 / $1,569.37	Professional		$335.47	$341.52	$1,569.37
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $73.97 / $79.08 / $98.85	Professional	26	$73.97	$79.08	$98.85
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $253.28 / $262.44 / $456.96	Professional	TC	$253.28	$262.44	$456.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $183.32 / $468.22 / $765.69	Professional		$183.32	$468.22	$765.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.04 / $91.01 / $164.97	Professional	26	$56.04	$91.01	$164.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.28 / $336.81 / $606.41	Professional	TC	$125.28	$336.81	$606.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $189.52 / $227.48 / $280.56	Professional		$189.52	$227.48	$280.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.72 / $76.23 / $92.87	Professional	26	$61.72	$76.23	$92.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $127.81 / $153.37 / $187.95	Professional	TC	$127.81	$153.37	$187.95
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $104.00 / $120.00 / $216.12	Facility	26	$104.00	$120.00	$216.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $95.91 / $359.78 / $699.00	Professional		$95.91	$359.78	$699.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $98.80 / $396.58 / $779.73	Professional		$98.80	$396.58	$779.73
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $73.64 / $97.36 / $154.15	Professional	26	$73.64	$97.36	$154.15
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $152.29 / $283.11 / $524.85	Professional	TC	$152.29	$283.11	$524.85
United Facility/Professional Professional Modifier Low / Median / High Price $181.55 / $315.08 / $733.31	Professional		$181.55	$315.08	$733.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.72 / $87.83 / $145.46	Professional	26	$53.72	$87.83	$145.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $121.86 / $243.67 / $603.66	Professional	TC	$121.86	$243.67	$603.66