Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.35 / $178.62 / $333.99	Facility	26	$100.35	$178.62	$333.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $263.20 / $319.20 / $624.38	Professional		$263.20	$319.20	$624.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.34 / $120.26 / $215.49	Professional	26	$93.34	$120.26	$215.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.91 / $198.94 / $408.90	Professional	TC	$158.91	$198.94	$408.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $298.56 / $378.75 / $643.24	Professional		$298.56	$378.75	$643.24
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.64 / $127.78 / $197.07	Professional	26	$102.64	$127.78	$197.07
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $197.22 / $253.68 / $426.23	Professional	TC	$197.22	$253.68	$426.23
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $388.56 / $458.29 / $1,414.17	Professional		$388.56	$458.29	$1,414.17
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $119.61 / $123.84 / $151.90	Professional	26	$119.61	$123.84	$151.90
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $268.94 / $281.24 / $341.55	Professional	TC	$268.94	$281.24	$341.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.94 / $128.94 / $128.94	Facility	26	$128.94	$128.94	$128.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $311.27 / $596.42 / $953.10	Professional		$311.27	$596.42	$953.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.24 / $146.57 / $250.69	Professional	26	$91.24	$146.57	$250.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $202.73 / $447.82 / $671.05	Professional	TC	$202.73	$447.82	$671.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $313.48 / $376.18 / $463.85	Professional		$313.48	$376.18	$463.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.46 / $125.33 / $150.53	Professional	26	$101.46	$125.33	$150.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $212.02 / $254.42 / $311.79	Professional	TC	$212.02	$254.42	$311.79
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $165.87 / $166.88 / $347.92	Facility	26	$165.87	$166.88	$347.92
Medcost Facility/Professional Professional Modifier Low / Median / High Price $150.00 / $418.00 / $765.00	Professional		$150.00	$418.00	$765.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $147.56 / $391.76 / $690.00	Professional		$147.56	$391.76	$690.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $112.64 / $155.36 / $252.69	Professional	26	$112.64	$155.36	$252.69
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $205.31 / $273.76 / $411.74	Professional	TC	$205.31	$273.76	$411.74
United Facility/Professional Professional Modifier Low / Median / High Price $290.16 / $474.29 / $960.06	Professional		$290.16	$474.29	$960.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.06 / $132.99 / $217.96	Professional	26	$80.06	$132.99	$217.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $193.91 / $332.21 / $788.51	Professional	TC	$193.91	$332.21	$788.51