Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.58 / $120.47 / $270.48	Facility	26	$84.58	$120.47	$270.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $304.57 / $361.32 / $631.71	Professional		$304.57	$361.32	$631.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.58 / $101.98 / $183.40	Professional	26	$81.58	$101.98	$183.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $225.84 / $259.35 / $448.30	Professional	TC	$225.84	$259.35	$448.30
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $315.07 / $400.94 / $680.92	Professional		$315.07	$400.94	$680.92
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.47 / $107.48 / $169.60	Professional	26	$84.47	$107.48	$169.60
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $230.59 / $299.25 / $498.35	Professional	TC	$230.59	$299.25	$498.35
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $488.04 / $495.84 / $3,281.84	Professional		$488.04	$495.84	$3,281.84
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $105.35 / $116.94 / $163.29	Professional	26	$105.35	$116.94	$163.29
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $365.17 / $390.49 / $605.26	Professional	TC	$365.17	$390.49	$605.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.46 / $108.46 / $108.46	Facility	26	$108.46	$108.46	$108.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.14 / $533.32 / $913.32	Professional		$302.14	$533.32	$913.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.79 / $125.61 / $225.40	Professional	26	$76.79	$125.61	$225.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $224.10 / $389.45 / $672.67	Professional	TC	$224.10	$389.45	$672.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $329.69 / $395.63 / $485.04	Professional		$329.69	$395.63	$485.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $85.22 / $105.27 / $126.86	Professional	26	$85.22	$105.27	$126.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $244.47 / $293.36 / $359.51	Professional	TC	$244.47	$293.36	$359.51
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $142.26 / $165.24 / $327.00	Facility	26	$142.26	$165.24	$327.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $128.00 / $382.00 / $670.00	Professional		$128.00	$382.00	$670.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $127.21 / $472.62 / $822.97	Professional		$127.21	$472.62	$822.97
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $96.37 / $131.49 / $213.02	Professional	26	$96.37	$131.49	$213.02
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $268.45 / $411.08 / $609.94	Professional	TC	$268.45	$411.08	$609.94
United Facility/Professional Professional Modifier Low / Median / High Price $286.43 / $447.80 / $746.96	Professional		$286.43	$447.80	$746.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.22 / $119.62 / $184.98	Professional	26	$75.22	$119.62	$184.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $209.15 / $339.35 / $541.41	Professional	TC	$209.15	$339.35	$541.41