Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.50 / $138.19 / $251.15	Facility	26	$76.50	$138.19	$251.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $239.72 / $290.89 / $549.00	Professional		$239.72	$290.89	$549.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.80 / $91.95 / $164.86	Professional	26	$70.80	$91.95	$164.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.91 / $198.94 / $384.14	Professional	TC	$158.91	$198.94	$384.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $282.89 / $360.52 / $559.48	Professional		$282.89	$360.52	$559.48
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.08 / $95.22 / $149.87	Professional	26	$77.08	$95.22	$149.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $198.83 / $266.69 / $412.27	Professional	TC	$198.83	$266.69	$412.27
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $430.78 / $438.11 / $1,724.86	Professional		$430.78	$438.11	$1,724.86
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $99.37 / $99.37 / $126.20	Professional	26	$99.37	$99.37	$126.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $327.08 / $331.41 / $420.89	Professional	TC	$327.08	$331.41	$420.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.06 / $98.06 / $98.06	Facility	26	$98.06	$98.06	$98.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $266.45 / $514.16 / $807.50	Professional		$266.45	$514.16	$807.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.39 / $112.86 / $194.63	Professional	26	$69.39	$112.86	$194.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $202.21 / $398.24 / $629.64	Professional	TC	$202.21	$398.24	$629.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $298.27 / $357.94 / $438.70	Professional		$298.27	$357.94	$438.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.08 / $95.21 / $114.76	Professional	26	$77.08	$95.21	$114.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $221.20 / $265.44 / $325.30	Professional	TC	$221.20	$265.44	$325.30
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $136.28 / $156.00 / $277.12	Facility	26	$136.28	$156.00	$277.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $118.60 / $369.00 / $748.00	Professional		$118.60	$369.00	$748.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $125.56 / $442.43 / $752.73	Professional		$125.56	$442.43	$752.73
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $91.35 / $126.85 / $192.58	Professional	26	$91.35	$126.85	$192.58
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $181.74 / $340.40 / $525.39	Professional	TC	$181.74	$340.40	$525.39
United Facility/Professional Professional Modifier Low / Median / High Price $260.56 / $413.32 / $761.89	Professional		$260.56	$413.32	$761.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.38 / $110.66 / $173.87	Professional	26	$69.38	$110.66	$173.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.78 / $306.54 / $624.41	Professional	TC	$186.78	$306.54	$624.41