Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $151.36 / $407.38	Facility	26	$112.20	$151.36	$407.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $426.58 / $912.01	Professional		$234.42	$426.58	$912.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $123.03 / $218.78	Professional	26	$64.57	$123.03	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $288.40 / $562.34	Professional	TC	$169.82	$288.40	$562.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $316.23 / $524.81	Professional		$223.87	$316.23	$524.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $81.28 / $131.83	Professional	26	$60.26	$81.28	$131.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $229.09 / $389.05	Professional	TC	$162.18	$229.09	$389.05
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $346.74 / $1,737.80	Professional		$87.10	$346.74	$1,737.80
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $77.62 / $131.83	Professional	26	$64.57	$77.62	$131.83
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $251.19 / $380.19	Professional	TC	$223.87	$251.19	$380.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $102.33	Facility	26	$15.49	$72.44	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $467.74 / $776.25	Professional		$213.80	$467.74	$776.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $79.43 / $151.36	Professional	26	$48.98	$79.43	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $363.08 / $645.65	Professional	TC	$158.49	$363.08	$645.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $263.03 / $338.84	Professional		$218.78	$263.03	$338.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $70.79 / $89.13	Professional	26	$57.54	$70.79	$89.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $194.98 / $257.04	Professional	TC	$158.49	$194.98	$257.04
Medcost Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $758.58 / $758.58	Professional		$549.54	$758.58	$758.58
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $117.49 / $138.04	Professional	26	$95.50	$117.49	$138.04
Medcost Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $389.05	Professional		$380.19	$380.19	$389.05
Sentara Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $371.54 / $1,659.59	Professional		$83.18	$371.54	$1,659.59
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $85.11 / $141.25	Professional	26	$66.07	$85.11	$141.25
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $338.84 / $537.03	Professional	TC	$181.97	$338.84	$537.03
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $380.19 / $776.25	Professional		$208.93	$380.19	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $75.86 / $134.90	Professional	26	$43.65	$75.86	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $295.12 / $660.69	Professional	TC	$154.88	$295.12	$660.69