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 / $295.04	Facility	26	$118.59	$155.65	$295.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $277.64 / $425.00 / $636.54	Professional		$277.64	$425.00	$636.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.70 / $126.00 / $155.65	Professional	26	$84.70	$126.00	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $299.00 / $406.29	Professional	TC	$187.50	$299.00	$406.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $256.62 / $328.16 / $542.54	Professional		$256.62	$328.16	$542.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.13 / $96.30 / $149.00	Professional	26	$77.13	$96.30	$149.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $179.47 / $229.51 / $386.73	Professional	TC	$179.47	$229.51	$386.73
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $448.21 / $457.75 / $1,904.09	Professional		$448.21	$457.75	$1,904.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $90.59 / $96.33 / $120.41	Professional	26	$90.59	$96.33	$120.41
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $347.55 / $361.42 / $469.78	Professional	TC	$347.55	$361.42	$469.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.82 / $96.82 / $96.82	Facility	26	$96.82	$96.82	$96.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $253.93 / $562.09 / $938.82	Professional		$253.93	$562.09	$938.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.64 / $112.14 / $205.78	Professional	26	$68.64	$112.14	$205.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $182.97 / $411.21 / $755.29	Professional	TC	$182.97	$411.21	$755.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.02 / $315.64 / $387.80	Professional		$263.02	$315.64	$387.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.25 / $94.19 / $113.53	Professional	26	$76.25	$94.19	$113.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $186.79 / $224.15 / $274.69	Professional	TC	$186.79	$224.15	$274.69
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $127.50 / $148.00 / $264.14	Facility	26	$127.50	$148.00	$264.14
Medcost Facility/Professional Professional Modifier Low / Median / High Price $117.19 / $395.00 / $863.00	Professional		$117.19	$395.00	$863.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $120.94 / $435.74 / $884.93	Professional		$120.94	$435.74	$884.93
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $89.57 / $120.18 / $190.30	Professional	26	$89.57	$120.18	$190.30
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $221.98 / $327.26 / $585.54	Professional	TC	$221.98	$327.26	$585.54
United Facility/Professional Professional Modifier Low / Median / High Price $250.25 / $434.86 / $841.57	Professional		$250.25	$434.86	$841.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.64 / $106.66 / $173.78	Professional	26	$66.64	$106.66	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.62 / $327.94 / $705.89	Professional	TC	$177.62	$327.94	$705.89