Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $211.09 / $384.98	Facility	26	$118.59	$211.09	$384.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $376.07 / $507.32 / $819.00	Professional		$376.07	$507.32	$819.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.25 / $155.65 / $237.05	Professional	26	$117.25	$155.65	$237.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $255.88 / $348.98 / $562.52	Professional	TC	$255.88	$348.98	$562.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $344.51 / $440.55 / $728.36	Professional		$344.51	$440.55	$728.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $110.64 / $138.74 / $213.00	Professional	26	$110.64	$138.74	$213.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $233.56 / $298.68 / $493.80	Professional	TC	$233.56	$298.68	$493.80
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $596.91 / $601.34 / $1,268.68	Professional		$596.91	$601.34	$1,268.68
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $134.99 / $144.31 / $173.32	Professional	26	$134.99	$144.31	$173.32
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $452.30 / $462.68 / $738.28	Professional	TC	$452.30	$462.68	$738.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $340.74 / $677.81 / $1,119.36	Professional		$340.74	$677.81	$1,119.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $98.60 / $160.60 / $279.89	Professional	26	$98.60	$160.60	$279.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.13 / $505.65 / $816.21	Professional	TC	$239.13	$505.65	$816.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $349.78 / $419.73 / $517.36	Professional		$349.78	$419.73	$517.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.57 / $135.35 / $162.58	Professional	26	$109.57	$135.35	$162.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $240.21 / $288.25 / $353.25	Professional	TC	$240.21	$288.25	$353.25
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $192.45 / $214.93 / $375.15	Facility	26	$192.45	$214.93	$375.15
Medcost Facility/Professional Professional Modifier Low / Median / High Price $162.13 / $497.00 / $932.00	Professional		$162.13	$497.00	$932.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $156.94 / $610.96 / $942.61	Professional		$156.94	$610.96	$942.61
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $124.76 / $170.04 / $274.26	Professional	26	$124.76	$170.04	$274.26
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $290.61 / $495.99 / $682.06	Professional	TC	$290.61	$495.99	$682.06
United Facility/Professional Professional Modifier Low / Median / High Price $338.59 / $555.89 / $974.05	Professional		$338.59	$555.89	$974.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.36 / $148.85 / $248.30	Professional	26	$93.36	$148.85	$248.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $234.85 / $408.75 / $790.38	Professional	TC	$234.85	$408.75	$790.38