Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $128.66 / $277.70	Facility	26	$79.45	$128.66	$277.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $242.58 / $294.45 / $535.55	Professional		$242.58	$294.45	$535.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.63 / $95.56 / $165.34	Professional	26	$73.63	$95.56	$165.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.91 / $198.58 / $397.41	Professional	TC	$158.91	$198.58	$397.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $298.20 / $382.04 / $597.99	Professional		$298.20	$382.04	$597.99
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.36 / $98.77 / $155.76	Professional	26	$79.36	$98.77	$155.76
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $447.31 / $557.88 / $887.72	Professional	50	$447.31	$557.88	$887.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $210.21 / $280.16 / $434.03	Professional	TC	$210.21	$280.16	$434.03
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $434.15 / $462.91 / $1,599.85	Professional		$434.15	$462.91	$1,599.85
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $98.98 / $98.98 / $125.70	Professional	26	$98.98	$98.98	$125.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $335.17 / $344.00 / $425.67	Professional	TC	$335.17	$344.00	$425.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.96 / $101.96 / $101.96	Facility	26	$101.96	$101.96	$101.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $292.64 / $528.92 / $862.54	Professional		$292.64	$528.92	$862.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.09 / $114.26 / $198.48	Professional	26	$72.09	$114.26	$198.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $221.56 / $410.62 / $644.71	Professional	TC	$221.56	$410.62	$644.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $315.02 / $378.02 / $463.26	Professional		$315.02	$378.02	$463.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.06 / $98.90 / $119.17	Professional	26	$80.06	$98.90	$119.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $234.96 / $281.95 / $345.53	Professional	TC	$234.96	$281.95	$345.53
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $124.00 / $138.26 / $285.12	Facility	26	$124.00	$138.26	$285.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $123.28 / $384.00 / $747.00	Professional		$123.28	$384.00	$747.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $127.97 / $424.71 / $739.93	Professional		$127.97	$424.71	$739.93
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $95.46 / $131.35 / $199.41	Professional	26	$95.46	$131.35	$199.41
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $181.37 / $332.10 / $520.07	Professional	TC	$181.37	$332.10	$520.07
United Facility/Professional Professional Modifier Low / Median / High Price $286.30 / $463.43 / $750.53	Professional		$286.30	$463.43	$750.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.64 / $110.07 / $188.14	Professional	26	$70.64	$110.07	$188.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $209.92 / $342.91 / $579.07	Professional	TC	$209.92	$342.91	$579.07