Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.84 / $104.76 / $317.33	Facility	26	$80.84	$104.76	$317.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $142.94 / $159.75 / $337.02	Professional		$142.94	$159.75	$337.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.81 / $86.72 / $138.49	Professional	26	$57.81	$86.72	$138.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.07 / $73.03 / $229.33	Professional	TC	$62.07	$73.03	$229.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $149.25 / $191.78 / $314.61	Professional		$149.25	$191.78	$314.61
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.14 / $101.55 / $148.44	Professional	26	$72.14	$101.55	$148.44
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.38 / $84.89 / $177.14	Professional	TC	$66.38	$84.89	$177.14
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $193.39 / $193.39 / $1,731.82	Professional		$193.39	$193.39	$1,731.82
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $68.56 / $100.07 / $127.09	Professional	26	$68.56	$100.07	$127.09
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $93.32 / $93.32 / $176.37	Professional	TC	$93.32	$93.32	$176.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.26 / $105.26 / $105.26	Facility	26	$105.26	$105.26	$105.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.82 / $265.16 / $659.12	Professional		$129.82	$265.16	$659.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.72 / $93.10 / $194.28	Professional	26	$64.72	$93.10	$194.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.00 / $150.01 / $572.54	Professional	TC	$58.00	$150.01	$572.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $152.13 / $185.34 / $227.41	Professional		$152.13	$185.34	$227.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $82.03 / $101.33 / $121.26	Professional	26	$82.03	$101.33	$121.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.13 / $84.15 / $103.13	Professional	TC	$70.13	$84.15	$103.13
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $95.70 / $108.00 / $253.54	Facility	26	$95.70	$108.00	$253.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $86.00 / $209.00 / $452.29	Professional		$86.00	$209.00	$452.29
Sentara Facility/Professional Professional Modifier Low / Median / High Price $90.75 / $250.63 / $657.34	Professional		$90.75	$250.63	$657.34
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $73.29 / $105.78 / $183.69	Professional	26	$73.29	$105.78	$183.69
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $79.68 / $148.13 / $330.85	Professional	TC	$79.68	$148.13	$330.85
United Facility/Professional Professional Modifier Low / Median / High Price $144.12 / $268.80 / $756.66	Professional		$144.12	$268.80	$756.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.50 / $95.08 / $164.94	Professional	26	$58.50	$95.08	$164.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.75 / $123.09 / $500.71	Professional	TC	$63.75	$123.09	$500.71