Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.57 / $137.11 / $296.41	Facility	26	$91.57	$137.11	$296.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $231.89 / $277.33 / $467.34	Professional		$231.89	$277.33	$467.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $85.98 / $131.33	Professional	26	$55.00	$85.98	$131.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.91 / $198.94 / $350.77	Professional	TC	$158.91	$198.94	$350.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $281.70 / $360.13 / $557.88	Professional		$281.70	$360.13	$557.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.45 / $94.10 / $148.13	Professional	26	$75.45	$94.10	$148.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $198.83 / $266.31 / $413.97	Professional	TC	$198.83	$266.31	$413.97
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $428.82 / $436.26 / $1,713.29	Professional		$428.82	$436.26	$1,713.29
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $94.93 / $94.93 / $120.56	Professional	26	$94.93	$94.93	$120.56
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $300.49 / $333.89 / $424.04	Professional	TC	$300.49	$333.89	$424.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.97 / $96.97 / $96.97	Facility	26	$96.97	$96.97	$96.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $264.17 / $510.26 / $823.68	Professional		$264.17	$510.26	$823.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.53 / $111.42 / $191.88	Professional	26	$68.53	$111.42	$191.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $201.89 / $387.19 / $618.64	Professional	TC	$201.89	$387.19	$618.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $297.01 / $356.41 / $436.82	Professional		$297.01	$356.41	$436.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.13 / $94.05 / $113.34	Professional	26	$76.13	$94.05	$113.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $220.87 / $265.05 / $324.81	Professional	TC	$220.87	$265.05	$324.81
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $131.69 / $149.00 / $265.20	Facility	26	$131.69	$149.00	$265.20
Medcost Facility/Professional Professional Modifier Low / Median / High Price $117.20 / $368.00 / $739.00	Professional		$117.20	$368.00	$739.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $121.88 / $440.68 / $746.29	Professional		$121.88	$440.68	$746.29
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $91.12 / $121.66 / $191.06	Professional	26	$91.12	$121.66	$191.06
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $181.74 / $340.40 / $524.96	Professional	TC	$181.74	$340.40	$524.96
United Facility/Professional Professional Modifier Low / Median / High Price $259.98 / $422.47 / $765.60	Professional		$259.98	$422.47	$765.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.18 / $109.37 / $165.06	Professional	26	$67.18	$109.37	$165.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $187.07 / $313.93 / $643.49	Professional	TC	$187.07	$313.93	$643.49