Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.17 / $130.24 / $285.85	Facility	26	$73.17	$130.24	$285.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $215.49 / $267.79 / $426.19	Professional		$215.49	$267.79	$426.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.38 / $86.81 / $137.90	Professional	26	$68.38	$86.81	$137.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.90 / $179.39 / $283.00	Professional	TC	$136.90	$179.39	$283.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $212.61 / $274.25 / $416.19	Professional		$212.61	$274.25	$416.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $73.95 / $92.66 / $143.38	Professional	26	$73.95	$92.66	$143.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.80 / $179.60 / $271.70	Professional	TC	$138.80	$179.60	$271.70
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $323.76 / $329.98 / $1,053.44	Professional		$323.76	$329.98	$1,053.44
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $90.10 / $90.10 / $114.43	Professional	26	$90.10	$90.10	$114.43
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $217.57 / $239.88 / $304.64	Professional	TC	$217.57	$239.88	$304.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.84 / $93.84 / $93.84	Facility	26	$93.84	$93.84	$93.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $209.93 / $345.75 / $594.87	Professional		$209.93	$345.75	$594.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.37 / $107.52 / $182.80	Professional	26	$66.37	$107.52	$182.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.33 / $227.65 / $392.04	Professional	TC	$141.33	$227.65	$392.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $220.89 / $265.39 / $327.33	Professional		$220.89	$265.39	$327.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $73.42 / $90.70 / $109.76	Professional	26	$73.42	$90.70	$109.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $147.46 / $176.95 / $216.85	Professional	TC	$147.46	$176.95	$216.85
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $121.52 / $122.33 / $244.65	Facility	26	$121.52	$122.33	$244.65
Medcost Facility/Professional Professional Modifier Low / Median / High Price $110.00 / $279.00 / $471.00	Professional		$110.00	$279.00	$471.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $108.99 / $310.95 / $583.11	Professional		$108.99	$310.95	$583.11
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $82.57 / $113.14 / $183.71	Professional	26	$82.57	$113.14	$183.71
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $167.48 / $241.62 / $377.94	Professional	TC	$167.48	$241.62	$377.94
United Facility/Professional Professional Modifier Low / Median / High Price $199.36 / $316.13 / $502.37	Professional		$199.36	$316.13	$502.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.53 / $105.92 / $170.82	Professional	26	$64.53	$105.92	$170.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $126.80 / $212.57 / $351.39	Professional	TC	$126.80	$212.57	$351.39