Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.13 / $90.86 / $183.91	Facility	26	$50.13	$90.86	$183.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.61 / $118.33 / $260.23	Professional		$107.61	$118.33	$260.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.65 / $59.08 / $105.16	Professional	26	$49.65	$59.08	$105.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.57 / $67.97 / $177.47	Professional	TC	$52.57	$67.97	$177.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $116.47 / $148.94 / $246.25	Professional		$116.47	$148.94	$246.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $59.81 / $74.45 / $108.79	Professional	26	$59.81	$74.45	$108.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.31 / $70.73 / $147.62	Professional	TC	$55.31	$70.73	$147.62
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $152.94 / $154.94 / $1,707.66	Professional		$152.94	$154.94	$1,707.66
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $59.64 / $61.50 / $76.88	Professional	26	$59.64	$61.50	$76.88
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $85.69 / $93.44 / $176.60	Professional	TC	$85.69	$93.44	$176.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.09 / $77.09 / $77.09	Facility	26	$77.09	$77.09	$77.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.59 / $208.38 / $648.19	Professional		$100.59	$208.38	$648.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.63 / $73.18 / $139.68	Professional	26	$50.63	$73.18	$139.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.21 / $116.92 / $554.96	Professional	TC	$48.21	$116.92	$554.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.74 / $142.66 / $175.96	Professional		$117.74	$142.66	$175.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.06 / $74.19 / $88.62	Professional	26	$60.06	$74.19	$88.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.67 / $69.20 / $84.81	Professional	TC	$57.67	$69.20	$84.81
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $82.70 / $111.00 / $357.00	Facility	26	$82.70	$111.00	$357.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $75.00 / $145.44 / $352.00	Professional		$75.00	$145.44	$352.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $76.03 / $191.85 / $641.09	Professional		$76.03	$191.85	$641.09
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $63.31 / $86.92 / $132.12	Professional	26	$63.31	$86.92	$132.12
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $68.98 / $114.19 / $286.42	Professional	TC	$68.98	$114.19	$286.42
United Facility/Professional Professional Modifier Low / Median / High Price $112.05 / $196.20 / $590.10	Professional		$112.05	$196.20	$590.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.69 / $79.00 / $122.09	Professional	26	$50.69	$79.00	$122.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.19 / $110.58 / $510.29	Professional	TC	$55.19	$110.58	$510.29