Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.17 / $126.08 / $236.29	Facility	26	$74.17	$126.08	$236.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $232.98 / $288.02 / $539.16	Professional		$232.98	$288.02	$539.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.58 / $89.07 / $173.72	Professional	26	$71.58	$89.07	$173.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.21 / $198.94 / $386.24	Professional	TC	$159.21	$198.94	$386.24
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.64 / $333.66 / $512.33	Professional		$257.64	$333.66	$512.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.29 / $93.73 / $144.88	Professional	26	$75.29	$93.73	$144.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.58 / $237.37 / $368.42	Professional	TC	$181.58	$237.37	$368.42
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $394.69 / $413.76 / $1,552.54	Professional		$394.69	$413.76	$1,552.54
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $91.20 / $115.82	Professional	26	$91.20	$91.20	$115.82
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $287.57 / $322.56 / $409.65	Professional	TC	$287.57	$322.56	$409.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $247.53 / $507.74 / $816.77	Professional		$247.53	$507.74	$816.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.95 / $108.83 / $200.00	Professional	26	$66.95	$108.83	$200.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $182.30 / $386.81 / $656.63	Professional	TC	$182.30	$386.81	$656.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.38 / $323.26 / $396.94	Professional		$269.38	$323.26	$396.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.08 / $91.51 / $111.25	Professional	26	$74.08	$91.51	$111.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $195.31 / $234.38 / $287.23	Professional	TC	$195.31	$234.38	$287.23
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $125.67 / $144.00 / $256.95	Facility	26	$125.67	$144.00	$256.95
Medcost Facility/Professional Professional Modifier Low / Median / High Price $114.87 / $361.00 / $905.00	Professional		$114.87	$361.00	$905.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $118.56 / $429.32 / $724.42	Professional		$118.56	$429.32	$724.42
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $88.14 / $122.35 / $185.75	Professional	26	$88.14	$122.35	$185.75
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $181.37 / $340.18 / $508.82	Professional	TC	$181.37	$340.18	$508.82
United Facility/Professional Professional Modifier Low / Median / High Price $239.09 / $388.52 / $714.29	Professional		$239.09	$388.52	$714.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.36 / $104.72 / $161.10	Professional	26	$65.36	$104.72	$161.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $172.33 / $308.70 / $583.79	Professional	TC	$172.33	$308.70	$583.79