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 / $363.08	Facility	26	$114.82	$154.88	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $426.58 / $912.01	Professional		$251.19	$426.58	$912.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $123.03 / $245.47	Professional	26	$70.79	$123.03	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $302.00 / $575.44	Professional	TC	$181.97	$302.00	$575.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $346.74 / $562.34	Professional		$245.47	$346.74	$562.34
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $91.20 / $144.54	Professional	26	$64.57	$91.20	$144.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $245.47 / $436.52	Professional	TC	$177.83	$245.47	$436.52
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $416.87 / $1,778.28	Professional		$309.03	$416.87	$1,778.28
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $97.72 / $138.04	Professional	26	$87.10	$97.72	$138.04
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $269.15 / $407.38	Professional	TC	$245.47	$269.15	$407.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $81.28 / $114.82	Facility	26	$17.38	$81.28	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $512.86 / $831.76	Professional		$229.09	$512.86	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $77.62 / $165.96	Professional	26	$52.48	$77.62	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $407.38 / $707.95	Professional	TC	$173.78	$407.38	$707.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $288.40 / $371.54	Professional		$239.88	$288.40	$371.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $79.43 / $100.00	Professional	26	$63.10	$79.43	$100.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $213.80 / $275.42	Professional	TC	$173.78	$213.80	$275.42
Medcost Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $758.58 / $776.25	Professional		$588.84	$758.58	$776.25
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $104.71 / $154.88	Professional	26	$83.18	$104.71	$154.88
Medcost Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $416.87 / $549.54	Professional		$416.87	$416.87	$549.54
Sentara Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $407.38 / $1,737.80	Professional		$79.43	$407.38	$1,737.80
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $83.18 / $141.25	Professional	26	$63.10	$83.18	$141.25
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $380.19 / $588.84	Professional	TC	$190.55	$380.19	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $398.11 / $812.83	Professional		$223.87	$398.11	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $75.86 / $138.04	Professional	26	$45.71	$75.86	$138.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $309.03 / $741.31	Professional	TC	$162.18	$309.03	$741.31