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 / $294.02	Facility	26	$118.59	$155.65	$294.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $342.51 / $475.00 / $655.93	Professional		$342.51	$475.00	$655.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.42 / $126.00 / $160.59	Professional	26	$85.42	$126.00	$160.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $255.30 / $335.00 / $489.03	Professional	TC	$255.30	$335.00	$489.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $316.54 / $404.79 / $669.23	Professional		$316.54	$404.79	$669.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.87 / $96.30 / $148.13	Professional	26	$76.87	$96.30	$148.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $239.40 / $306.14 / $506.15	Professional	TC	$239.40	$306.14	$506.15
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $564.13 / $568.45 / $1,633.67	Professional		$564.13	$568.45	$1,633.67
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $90.48 / $97.00 / $121.25	Professional	26	$90.48	$97.00	$121.25
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $424.30 / $471.45 / $598.74	Professional	TC	$424.30	$471.45	$598.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.95 / $96.95 / $96.95	Facility	26	$96.95	$96.95	$96.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $314.91 / $595.39 / $978.94	Professional		$314.91	$595.39	$978.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.54 / $111.53 / $201.53	Professional	26	$68.54	$111.53	$201.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $243.77 / $471.65 / $774.87	Professional	TC	$243.77	$471.65	$774.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $325.20 / $390.24 / $478.24	Professional		$325.20	$390.24	$478.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.81 / $93.66 / $113.83	Professional	26	$75.81	$93.66	$113.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $249.38 / $299.26 / $366.74	Professional	TC	$249.38	$299.26	$366.74
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $130.07 / $149.00 / $270.39	Facility	26	$130.07	$149.00	$270.39
Medcost Facility/Professional Professional Modifier Low / Median / High Price $117.67 / $489.00 / $855.00	Professional		$117.67	$489.00	$855.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $122.34 / $524.86 / $898.75	Professional		$122.34	$524.86	$898.75
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $90.35 / $120.66 / $191.06	Professional	26	$90.35	$120.66	$191.06
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $295.61 / $434.72 / $663.96	Professional	TC	$295.61	$434.72	$663.96
United Facility/Professional Professional Modifier Low / Median / High Price $309.45 / $513.28 / $832.98	Professional		$309.45	$513.28	$832.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.90 / $109.37 / $181.75	Professional	26	$66.90	$109.37	$181.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $236.54 / $388.00 / $685.82	Professional	TC	$236.54	$388.00	$685.82