Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.37 / $176.87 / $320.08	Facility	26	$99.37	$176.87	$320.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $264.08 / $319.51 / $636.16	Professional		$264.08	$319.51	$636.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.64 / $120.56 / $217.19	Professional	26	$92.64	$120.56	$217.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.85 / $198.94 / $408.90	Professional	TC	$158.85	$198.94	$408.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $335.25 / $472.94 / $746.06	Professional		$335.25	$472.94	$746.06
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $101.88 / $124.46 / $195.96	Professional	26	$101.88	$124.46	$195.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $246.16 / $348.72 / $550.11	Professional	TC	$246.16	$348.72	$550.11
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $488.03 / $588.73 / $2,255.15	Professional		$488.03	$588.73	$2,255.15
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $124.56 / $124.56 / $158.19	Professional	26	$124.56	$124.56	$158.19
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $363.47 / $403.45 / $654.28	Professional	TC	$363.47	$403.45	$654.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $353.84 / $656.74 / $1,097.33	Professional		$353.84	$656.74	$1,097.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.63 / $147.41 / $248.24	Professional	26	$90.63	$147.41	$248.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $258.83 / $499.51 / $807.96	Professional	TC	$258.83	$499.51	$807.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $400.98 / $481.17 / $589.67	Professional		$400.98	$481.17	$589.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $100.47 / $124.11 / $149.05	Professional	26	$100.47	$124.11	$149.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $300.51 / $360.61 / $441.93	Professional	TC	$300.51	$360.61	$441.93
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $173.70 / $197.00 / $351.39	Facility	26	$173.70	$197.00	$351.39
Medcost Facility/Professional Professional Modifier Low / Median / High Price $154.37 / $420.02 / $882.00	Professional		$154.37	$420.02	$882.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $160.88 / $461.69 / $908.18	Professional		$160.88	$461.69	$908.18
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $120.24 / $166.59 / $252.91	Professional	26	$120.24	$166.59	$252.91
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $181.40 / $335.59 / $572.57	Professional	TC	$181.40	$335.59	$572.57
United Facility/Professional Professional Modifier Low / Median / High Price $353.16 / $557.19 / $995.58	Professional		$353.16	$557.19	$995.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.65 / $133.43 / $217.62	Professional	26	$88.65	$133.43	$217.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $261.44 / $424.84 / $768.53	Professional	TC	$261.44	$424.84	$768.53