Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.35 / $180.38 / $395.73	Facility	26	$122.35	$180.38	$395.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $191.78 / $233.54 / $383.15	Professional		$191.78	$233.54	$383.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $114.96 / $176.10	Professional	26	$55.00	$114.96	$176.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.67 / $111.20 / $220.00	Professional	TC	$97.67	$111.20	$220.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $292.81 / $476.39 / $692.12	Professional		$292.81	$476.39	$692.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $101.96 / $125.90 / $183.36	Professional	26	$101.96	$125.90	$183.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.00 / $350.94 / $508.79	Professional	TC	$190.00	$350.94	$508.79
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $518.07 / $594.48 / $886.96	Professional		$518.07	$594.48	$886.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $124.97 / $124.97 / $158.71	Professional	26	$124.97	$124.97	$158.71
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $393.10 / $393.10 / $499.24	Professional	TC	$393.10	$393.10	$499.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.66 / $129.66 / $129.66	Facility	26	$129.66	$129.66	$129.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $359.61 / $579.77 / $1,049.98	Professional		$359.61	$579.77	$1,049.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.42 / $139.47 / $253.17	Professional	26	$89.42	$139.47	$253.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $261.05 / $419.41 / $793.82	Professional	TC	$261.05	$419.41	$793.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $400.66 / $480.79 / $589.20	Professional		$400.66	$480.79	$589.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.43 / $126.54 / $152.02	Professional	26	$102.43	$126.54	$152.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $298.22 / $357.87 / $438.56	Professional	TC	$298.22	$357.87	$438.56
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $156.57 / $157.94 / $352.50	Facility	26	$156.57	$157.94	$352.50
Medcost Facility/Professional Professional Modifier Low / Median / High Price $153.00 / $455.00 / $795.00	Professional		$153.00	$455.00	$795.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $136.47 / $290.41 / $528.69	Professional		$136.47	$290.41	$528.69
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $108.66 / $156.29 / $253.30	Professional	26	$108.66	$156.29	$253.30
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $110.85 / $180.35 / $258.35	Professional	TC	$110.85	$180.35	$258.35
United Facility/Professional Professional Modifier Low / Median / High Price $353.52 / $564.59 / $871.18	Professional		$353.52	$564.59	$871.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.75 / $134.26 / $221.44	Professional	26	$81.75	$134.26	$221.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $244.84 / $398.57 / $650.17	Professional	TC	$244.84	$398.57	$650.17