Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $155.65 / $242.81	Facility	26	$118.59	$155.65	$242.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $272.08 / $425.00 / $575.38	Professional		$272.08	$425.00	$575.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.18 / $119.85 / $155.65	Professional	26	$70.18	$119.85	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.21 / $306.33 / $387.42	Professional	TC	$199.21	$306.33	$387.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $250.47 / $320.30 / $529.54	Professional		$250.47	$320.30	$529.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.87 / $78.97 / $123.52	Professional	26	$62.87	$78.97	$123.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $186.85 / $238.94 / $395.03	Professional	TC	$186.85	$238.94	$395.03
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $444.81 / $449.25 / $1,586.13	Professional		$444.81	$449.25	$1,586.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $76.31 / $82.96 / $99.76	Professional	26	$76.31	$82.96	$99.76
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $361.85 / $369.44 / $469.19	Professional	TC	$361.85	$369.44	$469.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.91 / $79.91 / $79.91	Facility	26	$79.91	$79.91	$79.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $250.50 / $498.52 / $795.58	Professional		$250.50	$498.52	$795.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.57 / $92.43 / $170.71	Professional	26	$56.57	$92.43	$170.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $192.23 / $405.33 / $630.25	Professional	TC	$192.23	$405.33	$630.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $255.65 / $306.77 / $375.95	Professional		$255.65	$306.77	$375.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.31 / $76.97 / $93.23	Professional	26	$62.31	$76.97	$93.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $193.34 / $232.01 / $284.33	Professional	TC	$193.34	$232.01	$284.33
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $123.00 / $218.97	Facility	26	$105.78	$123.00	$218.97
Medcost Facility/Professional Professional Modifier Low / Median / High Price $96.38 / $395.00 / $703.00	Professional		$96.38	$395.00	$703.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $100.32 / $430.60 / $730.55	Professional		$100.32	$430.60	$730.55
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $74.34 / $98.80 / $156.43	Professional	26	$74.34	$98.80	$156.43
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $230.92 / $339.59 / $536.63	Professional	TC	$230.92	$339.59	$536.63
United Facility/Professional Professional Modifier Low / Median / High Price $248.48 / $409.99 / $750.02	Professional		$248.48	$409.99	$750.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.67 / $88.67 / $147.36	Professional	26	$50.67	$88.67	$147.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $188.22 / $335.40 / $604.20	Professional	TC	$188.22	$335.40	$604.20