Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.50 / $87.54 / $223.28	Facility	26	$51.50	$87.54	$223.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $246.93 / $294.27 / $490.08	Professional		$246.93	$294.27	$490.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.50 / $69.48 / $143.22	Professional	26	$51.50	$69.48	$143.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.35 / $232.75 / $372.48	Professional	TC	$162.35	$232.75	$372.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $238.41 / $306.66 / $432.75	Professional		$238.41	$306.66	$432.75
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.78 / $63.67 / $96.32	Professional	26	$49.78	$63.67	$96.32
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.00 / $243.66 / $342.26	Professional	TC	$181.00	$243.66	$342.26
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $270.14 / $309.33 / $1,233.43	Professional		$270.14	$309.33	$1,233.43
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.99 / $65.73 / $124.23	Professional	26	$58.99	$65.73	$124.23
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $183.97 / $204.41 / $386.33	Professional	TC	$183.97	$204.41	$386.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.58 / $62.58 / $62.58	Facility	26	$62.58	$62.58	$62.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.80 / $400.40 / $619.17	Professional		$257.80	$400.40	$619.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.32 / $94.87 / $143.44	Professional	26	$53.32	$94.87	$143.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $201.64 / $309.57 / $498.28	Professional	TC	$201.64	$309.57	$498.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $248.37 / $310.77 / $386.59	Professional		$248.37	$310.77	$386.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.73 / $61.92 / $76.44	Professional	26	$48.73	$61.92	$76.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $196.72 / $250.57 / $313.01	Professional	TC	$196.72	$250.57	$313.01
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $95.71 / $150.00 / $190.00	Facility	26	$95.71	$150.00	$190.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $78.00 / $347.00 / $579.00	Professional		$78.00	$347.00	$579.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $108.10 / $341.34 / $650.62	Professional		$108.10	$341.34	$650.62
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $63.43 / $94.89 / $135.69	Professional	26	$63.43	$94.89	$135.69
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $205.47 / $296.39 / $491.27	Professional	TC	$205.47	$296.39	$491.27
United Facility/Professional Professional Modifier Low / Median / High Price $237.41 / $382.56 / $601.23	Professional		$237.41	$382.56	$601.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.61 / $79.77 / $132.16	Professional	26	$48.61	$79.77	$132.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $178.98 / $289.93 / $471.23	Professional	TC	$178.98	$289.93	$471.23