Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.83 / $95.81 / $183.91	Facility	26	$53.83	$95.81	$183.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $191.95 / $394.53	Professional		$171.00	$191.95	$394.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.82 / $64.76 / $116.29	Professional	26	$53.82	$64.76	$116.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $113.12 / $127.19 / $266.82	Professional	TC	$113.12	$127.19	$266.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $164.11 / $209.86 / $346.96	Professional		$164.11	$209.86	$346.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.01 / $68.80 / $106.00	Professional	26	$55.01	$68.80	$106.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $109.10 / $139.52 / $235.81	Professional	TC	$109.10	$139.52	$235.81
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $232.64 / $247.33 / $1,049.77	Professional		$232.64	$247.33	$1,049.77
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $66.39 / $78.31 / $99.18	Professional	26	$66.39	$78.31	$99.18
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $166.26 / $169.01 / $257.70	Professional	TC	$166.26	$169.01	$257.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.07 / $329.65 / $518.95	Professional		$151.07	$329.65	$518.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.95 / $79.45 / $146.38	Professional	26	$48.95	$79.45	$146.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.08 / $230.01 / $411.40	Professional	TC	$111.08	$230.01	$411.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $168.27 / $201.93 / $248.94	Professional		$168.27	$201.93	$248.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.91 / $66.59 / $80.75	Professional	26	$53.91	$66.59	$80.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $114.37 / $137.24 / $168.19	Professional	TC	$114.37	$137.24	$168.19
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $90.80 / $131.83 / $218.00	Facility	26	$90.80	$131.83	$218.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $83.39 / $227.37 / $462.00	Professional		$83.39	$227.37	$462.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $86.04 / $290.75 / $512.51	Professional		$86.04	$290.75	$512.51
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $64.34 / $84.96 / $134.53	Professional	26	$64.34	$84.96	$134.53
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $125.95 / $224.86 / $338.89	Professional	TC	$125.95	$224.86	$338.89
United Facility/Professional Professional Modifier Low / Median / High Price $154.08 / $272.58 / $463.46	Professional		$154.08	$272.58	$463.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.57 / $77.52 / $126.38	Professional	26	$47.57	$77.52	$126.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.40 / $174.20 / $383.74	Professional	TC	$102.40	$174.20	$383.74