Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.23 / $75.16 / $182.59	Facility	26	$42.23	$75.16	$182.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.63 / $275.51 / $436.57	Professional		$206.63	$275.51	$436.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.23 / $47.61 / $82.77	Professional	26	$42.23	$47.61	$82.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.49 / $233.28 / $366.55	Professional	TC	$162.49	$233.28	$366.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $241.28 / $317.81 / $446.40	Professional		$241.28	$317.81	$446.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.79 / $53.45 / $73.77	Professional	26	$41.79	$53.45	$73.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $199.93 / $265.29 / $372.64	Professional	TC	$199.93	$265.29	$372.64
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $248.61 / $276.23 / $1,012.82	Professional		$248.61	$276.23	$1,012.82
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $45.54 / $45.54 / $86.07	Professional	26	$45.54	$45.54	$86.07
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $207.63 / $230.70 / $436.02	Professional	TC	$207.63	$230.70	$436.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.19 / $52.19 / $52.19	Facility	26	$52.19	$52.19	$52.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $248.34 / $382.27 / $622.85	Professional		$248.34	$382.27	$622.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.62 / $61.97 / $106.99	Professional	26	$44.62	$61.97	$106.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $202.32 / $318.86 / $527.37	Professional	TC	$202.32	$318.86	$527.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $244.45 / $306.74 / $393.59	Professional		$244.45	$306.74	$393.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.54 / $51.46 / $63.46	Professional	26	$40.54	$51.46	$63.46
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $201.57 / $256.64 / $333.25	Professional	TC	$201.57	$256.64	$333.25
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $48.77 / $82.00 / $129.75	Facility	26	$48.77	$82.00	$129.75
Medcost Facility/Professional Professional Modifier Low / Median / High Price $62.72 / $340.00 / $539.80	Professional		$62.72	$340.00	$539.80
Sentara Facility/Professional Professional Modifier Low / Median / High Price $63.02 / $275.94 / $572.69	Professional		$63.02	$275.94	$572.69
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $50.25 / $65.58 / $102.34	Professional	26	$50.25	$65.58	$102.34
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $202.96 / $283.52 / $498.20	Professional	TC	$202.96	$283.52	$498.20
United Facility/Professional Professional Modifier Low / Median / High Price $220.34 / $354.69 / $537.28	Professional		$220.34	$354.69	$537.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.84 / $57.00 / $94.22	Professional	26	$37.84	$57.00	$94.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.63 / $296.64 / $468.13	Professional	TC	$181.63	$296.64	$468.13