Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.83 / $97.36 / $205.46	Facility	26	$53.83	$97.36	$205.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $204.38 / $421.73	Professional		$171.00	$204.38	$421.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.94 / $64.00 / $105.45	Professional	26	$51.94	$64.00	$105.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $139.62 / $288.45	Professional	TC	$119.70	$139.62	$288.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $174.25 / $222.83 / $368.40	Professional		$174.25	$222.83	$368.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.70 / $68.83 / $106.81	Professional	26	$54.70	$68.83	$106.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $119.55 / $152.88 / $272.00	Professional	TC	$119.55	$152.88	$272.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $263.04 / $287.83 / $1,069.81	Professional		$263.04	$287.83	$1,069.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $70.06 / $74.17 / $94.20	Professional	26	$70.06	$74.17	$94.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $185.20 / $213.67 / $271.36	Professional	TC	$185.20	$213.67	$271.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $160.24 / $357.53 / $569.52	Professional		$160.24	$357.53	$569.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.75 / $83.62 / $149.11	Professional	26	$49.75	$83.62	$149.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $121.88 / $258.56 / $460.02	Professional	TC	$121.88	$258.56	$460.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $178.76 / $214.52 / $264.02	Professional		$178.76	$214.52	$264.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.58 / $66.19 / $80.75	Professional	26	$53.58	$66.19	$80.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.18 / $150.22 / $184.09	Professional	TC	$125.18	$150.22	$184.09
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $101.40 / $117.00 / $209.79	Facility	26	$101.40	$117.00	$209.79
Medcost Facility/Professional Professional Modifier Low / Median / High Price $84.00 / $251.00 / $569.00	Professional		$84.00	$251.00	$569.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $93.67 / $332.21 / $617.94	Professional		$93.67	$332.21	$617.94
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $64.08 / $90.91 / $141.72	Professional	26	$64.08	$90.91	$141.72
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $139.32 / $261.17 / $400.23	Professional	TC	$139.32	$261.17	$400.23
United Facility/Professional Professional Modifier Low / Median / High Price $164.10 / $279.92 / $514.98	Professional		$164.10	$279.92	$514.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.18 / $77.52 / $120.94	Professional	26	$48.18	$77.52	$120.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.98 / $199.17 / $383.74	Professional	TC	$112.98	$199.17	$383.74