Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.62 / $155.65 / $239.54	Facility	26	$114.62	$155.65	$239.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $287.44 / $425.00 / $648.32	Professional		$287.44	$425.00	$648.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.48 / $118.69 / $155.65	Professional	26	$69.48	$118.69	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $217.94 / $299.26 / $433.05	Professional	TC	$217.94	$299.26	$433.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.14 / $403.34 / $672.44	Professional		$309.14	$403.34	$672.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.28 / $78.16 / $123.52	Professional	26	$62.28	$78.16	$123.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $241.95 / $323.58 / $544.48	Professional	TC	$241.95	$323.58	$544.48
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $508.70 / $514.41 / $1,569.37	Professional		$508.70	$514.41	$1,569.37
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $73.97 / $79.08 / $98.85	Professional	26	$73.97	$79.08	$98.85
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $389.43 / $432.70 / $549.53	Professional	TC	$389.43	$432.70	$549.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $322.17 / $566.87 / $951.26	Professional		$322.17	$566.87	$951.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.04 / $91.01 / $164.97	Professional	26	$56.04	$91.01	$164.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $264.13 / $474.36 / $814.49	Professional	TC	$264.13	$474.36	$814.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $328.47 / $394.17 / $483.05	Professional		$328.47	$394.17	$483.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.05 / $76.65 / $92.87	Professional	26	$62.05	$76.65	$92.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $266.43 / $319.72 / $391.81	Professional	TC	$266.43	$319.72	$391.81
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $105.26 / $120.00 / $215.35	Facility	26	$105.26	$120.00	$215.35
Medcost Facility/Professional Professional Modifier Low / Median / High Price $95.91 / $500.00 / $867.00	Professional		$95.91	$500.00	$867.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $99.41 / $440.13 / $748.38	Professional		$99.41	$440.13	$748.38
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $73.64 / $97.83 / $154.91	Professional	26	$73.64	$97.83	$154.91
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $237.86 / $374.10 / $535.89	Professional	TC	$237.86	$374.10	$535.89
United Facility/Professional Professional Modifier Low / Median / High Price $319.43 / $519.08 / $846.59	Professional		$319.43	$519.08	$846.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.23 / $84.38 / $144.38	Professional	26	$52.23	$84.38	$144.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $258.55 / $422.08 / $701.39	Professional	TC	$258.55	$422.08	$701.39