Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $107.15 / $380.19	Facility	26	$54.95	$107.15	$380.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $263.03 / $588.84	Professional		$208.93	$263.03	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $63.10 / $104.71	Professional	26	$52.48	$63.10	$104.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $186.21 / $457.09	Professional	TC	$151.36	$186.21	$457.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $436.52	Professional		$208.93	$295.12	$436.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $77.62 / $112.20	Professional	26	$56.23	$77.62	$112.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $213.80 / $316.23	Professional	TC	$151.36	$213.80	$316.23
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $354.81 / $2,454.71	Professional		$79.43	$354.81	$2,454.71
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $72.44 / $123.03	Professional	26	$45.71	$72.44	$123.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $288.40 / $363.08	Professional	TC	$229.09	$288.40	$363.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $346.74 / $741.31	Professional		$186.21	$346.74	$741.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $77.62 / $125.89	Professional	26	$50.12	$77.62	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $251.19 / $660.69	Professional	TC	$134.90	$251.19	$660.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $295.12 / $323.59	Professional		$218.78	$295.12	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $77.62 / $83.18	Professional	26	$58.88	$77.62	$83.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $213.80 / $234.42	Professional	TC	$162.18	$213.80	$234.42
Medcost Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,122.02 / $1,380.38	Professional		$1,096.48	$1,122.02	$1,380.38
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $89.13 / $104.71	Professional	26	$83.18	$89.13	$104.71
Medcost Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $371.54 / $371.54	Professional		$371.54	$371.54	$371.54
Sentara Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $288.40 / $831.76	Professional		$72.44	$288.40	$831.76
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $83.18 / $151.36	Professional	26	$58.88	$83.18	$151.36
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $316.23 / $616.60	Professional	TC	$162.18	$316.23	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $346.74 / $741.31	Professional		$218.78	$346.74	$741.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $77.62 / $109.65	Professional	26	$35.48	$77.62	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $251.19 / $660.69	Professional	TC	$158.49	$251.19	$660.69