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 / $294.02	Facility	26	$118.59	$155.65	$294.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $344.73 / $475.00 / $734.81	Professional		$344.73	$475.00	$734.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.75 / $126.00 / $155.65	Professional	26	$84.75	$126.00	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $258.58 / $335.00 / $494.53	Professional	TC	$258.58	$335.00	$494.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $319.31 / $408.33 / $675.09	Professional		$319.31	$408.33	$675.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.83 / $96.08 / $147.56	Professional	26	$76.83	$96.08	$147.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $242.48 / $310.08 / $512.65	Professional	TC	$242.48	$310.08	$512.65
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $569.69 / $577.20 / $1,631.49	Professional		$569.69	$577.20	$1,631.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $93.40 / $100.14 / $128.94	Professional	26	$93.40	$100.14	$128.94
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $432.90 / $481.00 / $610.87	Professional	TC	$432.90	$481.00	$610.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $318.35 / $583.52 / $1,011.04	Professional		$318.35	$583.52	$1,011.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.28 / $111.12 / $209.27	Professional	26	$68.28	$111.12	$209.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $247.47 / $477.06 / $770.91	Professional	TC	$247.47	$477.06	$770.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $329.15 / $394.98 / $484.05	Professional		$329.15	$394.98	$484.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.84 / $93.69 / $113.40	Professional	26	$75.84	$93.69	$113.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $253.31 / $303.97 / $372.51	Professional	TC	$253.31	$303.97	$372.51
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $129.99 / $148.00 / $268.00	Facility	26	$129.99	$148.00	$268.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $117.20 / $495.00 / $861.00	Professional		$117.20	$495.00	$861.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $121.23 / $528.64 / $907.06	Professional		$121.23	$528.64	$907.06
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $90.28 / $120.18 / $190.30	Professional	26	$90.28	$120.18	$190.30
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $299.54 / $440.50 / $677.03	Professional	TC	$299.54	$440.50	$677.03
United Facility/Professional Professional Modifier Low / Median / High Price $308.42 / $507.52 / $840.98	Professional		$308.42	$507.52	$840.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.62 / $100.44 / $169.99	Professional	26	$56.62	$100.44	$169.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $239.70 / $389.51 / $678.42	Professional	TC	$239.70	$389.51	$678.42