Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $154.88 / $446.68	Facility	26	$114.82	$154.88	$446.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $436.52 / $1,023.29	Professional		$269.15	$436.52	$1,023.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $125.89 / $204.17	Professional	26	$70.79	$125.89	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $309.03 / $512.86	Professional	TC	$199.53	$309.03	$512.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $354.81 / $602.56	Professional		$257.04	$354.81	$602.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $89.13 / $144.54	Professional	26	$64.57	$89.13	$144.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $269.15 / $457.09	Professional	TC	$194.98	$269.15	$457.09
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $446.68 / $1,862.09	Professional		$354.81	$446.68	$1,862.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $95.50 / $134.90	Professional	26	$85.11	$95.50	$134.90
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $295.12 / $446.68	Professional	TC	$269.15	$295.12	$446.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	26	$16.98	$79.43	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $501.19 / $812.83	Professional		$251.19	$501.19	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $87.10 / $158.49	Professional	26	$53.70	$87.10	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $389.05 / $645.65	Professional	TC	$190.55	$389.05	$645.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $309.03 / $398.11	Professional		$257.04	$309.03	$398.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $75.86 / $97.72	Professional	26	$61.66	$75.86	$97.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $229.09 / $309.03	Professional	TC	$190.55	$229.09	$309.03
Medcost Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $776.25 / $794.33	Professional		$630.96	$776.25	$794.33
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $131.83 / $151.36	Professional	26	$104.71	$131.83	$151.36
Medcost Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $446.68 / $457.09	Professional		$446.68	$446.68	$457.09
Sentara Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $389.05 / $1,621.81	Professional		$91.20	$389.05	$1,621.81
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $93.33 / $154.88	Professional	26	$72.44	$93.33	$154.88
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $331.13 / $537.03	Professional	TC	$218.78	$331.13	$537.03
United Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $407.38 / $776.25	Professional		$245.47	$407.38	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $83.18 / $144.54	Professional	26	$47.86	$83.18	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $323.59 / $645.65	Professional	TC	$186.21	$323.59	$645.65