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 / $327.43	Facility	26	$118.59	$155.65	$327.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $282.77 / $425.00 / $603.46	Professional		$282.77	$425.00	$603.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $126.00 / $157.77	Professional	26	$85.00	$126.00	$157.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $195.98 / $299.00 / $409.84	Professional	TC	$195.98	$299.00	$409.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $261.22 / $334.05 / $552.28	Professional		$261.22	$334.05	$552.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.44 / $96.86 / $149.83	Professional	26	$77.44	$96.86	$149.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $183.77 / $235.01 / $391.52	Professional	TC	$183.77	$235.01	$391.52
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $456.95 / $456.98 / $1,924.00	Professional		$456.95	$456.98	$1,924.00
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $92.47 / $100.92 / $128.16	Professional	26	$92.47	$100.92	$128.16
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $355.88 / $360.19 / $469.01	Professional	TC	$355.88	$360.19	$469.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.16 / $97.16 / $97.16	Facility	26	$97.16	$97.16	$97.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.95 / $569.75 / $963.21	Professional		$239.95	$569.75	$963.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.93 / $113.47 / $202.96	Professional	26	$68.93	$113.47	$202.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $187.29 / $419.82 / $755.29	Professional	TC	$187.29	$419.82	$755.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $267.95 / $321.52 / $394.86	Professional		$267.95	$321.52	$394.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.56 / $94.58 / $114.02	Professional	26	$76.56	$94.58	$114.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $191.38 / $229.65 / $281.44	Professional	TC	$191.38	$229.65	$281.44
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $137.34 / $159.00 / $283.98	Facility	26	$137.34	$159.00	$283.98
Medcost Facility/Professional Professional Modifier Low / Median / High Price $117.66 / $400.00 / $877.00	Professional		$117.66	$400.00	$877.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $127.77 / $443.93 / $896.62	Professional		$127.77	$443.93	$896.62
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $90.56 / $126.80 / $190.30	Professional	26	$90.56	$126.80	$190.30
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $226.63 / $334.68 / $585.54	Professional	TC	$226.63	$334.68	$585.54
United Facility/Professional Professional Modifier Low / Median / High Price $254.26 / $440.21 / $848.42	Professional		$254.26	$440.21	$848.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.56 / $107.13 / $181.67	Professional	26	$67.56	$107.13	$181.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.35 / $333.89 / $705.89	Professional	TC	$181.35	$333.89	$705.89