Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $136.72 / $205.07 / $408.40	Facility	26	$136.72	$205.07	$408.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $255.18 / $268.70 / $519.40	Professional		$255.18	$268.70	$519.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.81 / $137.63 / $270.67	Professional	26	$131.81	$137.63	$270.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.27 / $131.99 / $248.72	Professional	TC	$123.27	$131.99	$248.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $264.91 / $337.68 / $464.62	Professional		$264.91	$337.68	$464.62
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $139.21 / $177.46 / $244.16	Professional	26	$139.21	$177.46	$244.16
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.69 / $159.58 / $220.45	Professional	TC	$125.69	$159.58	$220.45
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $323.26 / $323.26 / $683.94	Professional		$323.26	$323.26	$683.94
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $161.44 / $161.44 / $161.44	Professional	26	$161.44	$161.44	$161.44
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $161.81 / $161.81 / $161.81	Professional	TC	$161.81	$161.81	$161.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.11 / $173.11 / $173.11	Facility	26	$173.11	$173.11	$173.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $252.10 / $381.87 / $721.57	Professional		$252.10	$381.87	$721.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $129.37 / $201.03 / $378.46	Professional	26	$129.37	$201.03	$378.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $119.45 / $180.44 / $337.02	Professional	TC	$119.45	$180.44	$337.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $287.27 / $386.70 / $406.20	Professional		$287.27	$386.70	$406.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $151.28 / $198.44 / $206.71	Professional	26	$151.28	$198.44	$206.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $136.00 / $189.92 / $194.59	Professional	TC	$136.00	$189.92	$194.59
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $176.98 / $219.66 / $451.29	Facility	26	$176.98	$219.66	$451.29
Medcost Facility/Professional Professional Modifier Low / Median / High Price $174.00 / $248.00 / $473.61	Professional		$174.00	$248.00	$473.61
Sentara Facility/Professional Professional Modifier Low / Median / High Price $145.96 / $319.69 / $2,541.00	Professional		$145.96	$319.69	$2,541.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $148.94 / $218.43 / $333.29	Professional	26	$148.94	$218.43	$333.29
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $131.99 / $195.26 / $299.47	Professional	TC	$131.99	$195.26	$299.47
United Facility/Professional Professional Modifier Low / Median / High Price $234.97 / $381.82 / $616.74	Professional		$234.97	$381.82	$616.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $125.23 / $191.48 / $315.60	Professional	26	$125.23	$191.48	$315.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.74 / $178.33 / $284.99	Professional	TC	$109.74	$178.33	$284.99