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 / $242.81	Facility	26	$118.59	$155.65	$242.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $322.37 / $475.00 / $683.42	Professional		$322.37	$475.00	$683.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.31 / $126.00 / $166.95	Professional	26	$78.31	$126.00	$166.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $241.83 / $340.00 / $487.65	Professional	TC	$241.83	$340.00	$487.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $297.18 / $380.03 / $628.29	Professional		$297.18	$380.03	$628.29
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.84 / $85.79 / $136.16	Professional	26	$68.84	$85.79	$136.16
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $226.80 / $290.02 / $479.50	Professional	TC	$226.80	$290.02	$479.50
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $531.07 / $539.55 / $1,857.85	Professional		$531.07	$539.55	$1,857.85
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $82.68 / $88.78 / $110.97	Professional	26	$82.68	$88.78	$110.97
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $439.20 / $450.78 / $631.09	Professional	TC	$439.20	$450.78	$631.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.30 / $88.30 / $88.30	Facility	26	$88.30	$88.30	$88.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $296.83 / $585.27 / $962.91	Professional		$296.83	$585.27	$962.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.64 / $101.75 / $184.00	Professional	26	$62.64	$101.75	$184.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $232.34 / $482.71 / $763.15	Professional	TC	$232.34	$482.71	$763.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $303.63 / $364.35 / $446.51	Professional		$303.63	$364.35	$446.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.98 / $85.23 / $103.19	Professional	26	$68.98	$85.23	$103.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $234.64 / $281.57 / $345.06	Professional	TC	$234.64	$281.57	$345.06
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $115.86 / $133.00 / $240.13	Facility	26	$115.86	$133.00	$240.13
Medcost Facility/Professional Professional Modifier Low / Median / High Price $109.99 / $464.00 / $824.00	Professional		$109.99	$464.00	$824.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $108.59 / $537.96 / $870.54	Professional		$108.59	$537.96	$870.54
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $81.81 / $110.13 / $174.38	Professional	26	$81.81	$110.13	$174.38
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $284.91 / $476.42 / $645.95	Professional	TC	$284.91	$476.42	$645.95
United Facility/Professional Professional Modifier Low / Median / High Price $294.56 / $479.09 / $835.31	Professional		$294.56	$479.09	$835.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.26 / $98.67 / $157.56	Professional	26	$58.26	$98.67	$157.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $227.99 / $396.58 / $698.68	Professional	TC	$227.99	$396.58	$698.68