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 / $295.30	Facility	26	$118.59	$155.65	$295.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $342.85 / $461.61 / $658.21	Professional		$342.85	$461.61	$658.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $126.00 / $155.65	Professional	26	$85.00	$126.00	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $256.94 / $335.00 / $490.25	Professional	TC	$256.94	$335.00	$490.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $318.39 / $407.15 / $673.14	Professional		$318.39	$407.15	$673.14
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.84 / $96.69 / $148.74	Professional	26	$76.84	$96.69	$148.74
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $477.58 / $610.72 / $1,009.71	Professional	50	$477.58	$610.72	$1,009.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $240.94 / $308.11 / $509.39	Professional	TC	$240.94	$308.11	$509.39
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $567.48 / $573.66 / $1,634.70	Professional		$567.48	$573.66	$1,634.70
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $90.81 / $96.51 / $120.64	Professional	26	$90.81	$96.51	$120.64
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $429.44 / $477.16 / $605.99	Professional	TC	$429.44	$477.16	$605.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.37 / $97.37 / $97.37	Facility	26	$97.37	$97.37	$97.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.41 / $586.48 / $985.28	Professional		$316.41	$586.48	$985.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.80 / $112.45 / $209.95	Professional	26	$68.80	$112.45	$209.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.31 / $476.97 / $773.17	Professional	TC	$245.31	$476.97	$773.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $329.08 / $394.89 / $483.94	Professional		$329.08	$394.89	$483.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.42 / $94.41 / $113.77	Professional	26	$76.42	$94.41	$113.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $252.65 / $303.18 / $371.55	Professional	TC	$252.65	$303.18	$371.55
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $116.29 / $150.00 / $270.48	Facility	26	$116.29	$150.00	$270.48
Medcost Facility/Professional Professional Modifier Low / Median / High Price $117.67 / $493.00 / $868.00	Professional		$117.67	$493.00	$868.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $122.10 / $518.64 / $904.58	Professional		$122.10	$518.64	$904.58
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $91.00 / $120.66 / $191.06	Professional	26	$91.00	$120.66	$191.06
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $297.75 / $437.87 / $675.56	Professional	TC	$297.75	$437.87	$675.56
United Facility/Professional Professional Modifier Low / Median / High Price $311.45 / $518.41 / $843.53	Professional		$311.45	$518.41	$843.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.90 / $107.33 / $181.96	Professional	26	$67.90	$107.33	$181.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $238.25 / $389.15 / $688.90	Professional	TC	$238.25	$389.15	$688.90