Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.37 / $100.33 / $291.70	Facility	26	$56.37	$100.33	$291.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $210.93 / $256.76 / $428.25	Professional		$210.93	$256.76	$428.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.37 / $71.31 / $126.50	Professional	26	$56.37	$71.31	$126.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.75 / $171.78 / $312.35	Professional	TC	$152.75	$171.78	$312.35
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $203.55 / $258.58 / $387.92	Professional		$203.55	$258.58	$387.92
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.16 / $70.73 / $106.12	Professional	26	$56.16	$70.73	$106.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $146.88 / $187.85 / $281.81	Professional	TC	$146.88	$187.85	$281.81
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $229.67 / $255.19 / $727.55	Professional		$229.67	$255.19	$727.55
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $65.55 / $68.34 / $129.16	Professional	26	$65.55	$68.34	$129.16
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $166.68 / $166.68 / $315.02	Professional	TC	$166.68	$166.68	$315.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.50 / $69.50 / $69.50	Facility	26	$69.50	$69.50	$69.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $217.55 / $295.26 / $567.66	Professional		$217.55	$295.26	$567.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.51 / $85.96 / $159.69	Professional	26	$61.51	$85.96	$159.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.97 / $211.06 / $418.97	Professional	TC	$154.97	$211.06	$418.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $205.54 / $255.11 / $317.02	Professional		$205.54	$255.11	$317.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.14 / $68.79 / $85.47	Professional	26	$54.14	$68.79	$85.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $147.78 / $188.23 / $236.50	Professional	TC	$147.78	$188.23	$236.50
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $71.09 / $109.00 / $168.38	Facility	26	$71.09	$109.00	$168.38
Medcost Facility/Professional Professional Modifier Low / Median / High Price $83.64 / $228.00 / $375.22	Professional		$83.64	$228.00	$375.22
Sentara Facility/Professional Professional Modifier Low / Median / High Price $86.61 / $256.86 / $496.93	Professional		$86.61	$256.86	$496.93
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $67.23 / $87.57 / $136.33	Professional	26	$67.23	$87.57	$136.33
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $159.54 / $218.32 / $378.89	Professional	TC	$159.54	$218.32	$378.89
United Facility/Professional Professional Modifier Low / Median / High Price $183.31 / $271.22 / $458.58	Professional		$183.31	$271.22	$458.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.00 / $79.20 / $126.56	Professional	26	$52.00	$79.20	$126.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $133.97 / $203.63 / $352.27	Professional	TC	$133.97	$203.63	$352.27