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 / $292.94	Facility	26	$118.59	$155.65	$292.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $344.09 / $475.00 / $737.59	Professional		$344.09	$475.00	$737.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.75 / $126.00 / $155.65	Professional	26	$84.75	$126.00	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.33 / $335.00 / $493.31	Professional	TC	$259.33	$335.00	$493.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $320.54 / $409.90 / $677.68	Professional		$320.54	$409.90	$677.68
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.94 / $95.92 / $147.56	Professional	26	$75.94	$95.92	$147.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $243.71 / $311.64 / $515.25	Professional	TC	$243.71	$311.64	$515.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $570.26 / $573.05 / $1,631.49	Professional		$570.26	$573.05	$1,631.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $90.13 / $96.20 / $120.25	Professional	26	$90.13	$96.20	$120.25
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $429.18 / $476.86 / $605.61	Professional	TC	$429.18	$476.86	$605.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $293.58 / $578.02 / $1,007.98	Professional		$293.58	$578.02	$1,007.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.28 / $111.08 / $199.94	Professional	26	$68.28	$111.08	$199.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $248.09 / $474.95 / $765.20	Professional	TC	$248.09	$474.95	$765.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $330.79 / $396.95 / $486.46	Professional		$330.79	$396.95	$486.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.17 / $94.09 / $113.40	Professional	26	$76.17	$94.09	$113.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $254.63 / $305.55 / $374.45	Professional	TC	$254.63	$305.55	$374.45
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $114.92 / $153.00 / $267.30	Facility	26	$114.92	$153.00	$267.30
Medcost Facility/Professional Professional Modifier Low / Median / High Price $117.20 / $493.00 / $862.00	Professional		$117.20	$493.00	$862.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $120.93 / $516.83 / $902.90	Professional		$120.93	$516.83	$902.90
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $90.08 / $119.70 / $189.53	Professional	26	$90.08	$119.70	$189.53
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $298.11 / $438.40 / $675.56	Professional	TC	$298.11	$438.40	$675.56
United Facility/Professional Professional Modifier Low / Median / High Price $310.89 / $517.40 / $840.57	Professional		$310.89	$517.40	$840.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.11 / $106.06 / $171.73	Professional	26	$67.11	$106.06	$171.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $238.54 / $393.60 / $687.86	Professional	TC	$238.54	$393.60	$687.86