Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $136.38 / $241.76 / $563.47	Facility	26	$136.38	$241.76	$563.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $317.47 / $402.89 / $626.22	Professional		$317.47	$402.89	$626.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $130.58 / $137.63 / $249.47	Professional	26	$130.58	$137.63	$249.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $185.65 / $268.27 / $346.66	Professional	TC	$185.65	$268.27	$346.66
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $414.28 / $532.88 / $745.87	Professional		$414.28	$532.88	$745.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $135.88 / $174.54 / $243.63	Professional	26	$135.88	$174.54	$243.63
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $278.39 / $355.91 / $499.11	Professional	TC	$278.39	$355.91	$499.11
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $405.28 / $533.57 / $1,127.54	Professional		$405.28	$533.57	$1,127.54
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $162.37 / $166.22 / $166.22	Professional	26	$162.37	$166.22	$166.22
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $242.91 / $367.35 / $367.35	Professional	TC	$242.91	$367.35	$367.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $172.76 / $172.76 / $172.76	Facility	26	$172.76	$172.76	$172.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $358.62 / $497.84 / $1,095.31	Professional		$358.62	$497.84	$1,095.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $129.10 / $200.98 / $377.55	Professional	26	$129.10	$200.98	$377.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $207.36 / $287.12 / $682.27	Professional	TC	$207.36	$287.12	$682.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $456.80 / $623.42 / $654.86	Professional		$456.80	$623.42	$654.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $150.94 / $197.98 / $206.23	Professional	26	$150.94	$197.98	$206.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $305.85 / $427.09 / $437.68	Professional	TC	$305.85	$427.09	$437.68
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $219.66 / $219.66 / $450.29	Facility	26	$219.66	$219.66	$450.29
Medcost Facility/Professional Professional Modifier Low / Median / High Price $190.00 / $357.31 / $726.29	Professional		$190.00	$357.31	$726.29
Sentara Facility/Professional Professional Modifier Low / Median / High Price $181.58 / $398.88 / $957.26	Professional		$181.58	$398.88	$957.26
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $148.94 / $218.43 / $332.53	Professional	26	$148.94	$218.43	$332.53
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $198.65 / $346.18 / $623.58	Professional	TC	$198.65	$346.18	$623.58
United Facility/Professional Professional Modifier Low / Median / High Price $317.13 / $496.97 / $709.85	Professional		$317.13	$496.97	$709.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $124.94 / $193.07 / $282.83	Professional	26	$124.94	$193.07	$282.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $206.37 / $309.56 / $465.02	Professional	TC	$206.37	$309.56	$465.02