Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.74 / $92.09 / $201.29	Facility	26	$51.74	$92.09	$201.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $168.59 / $229.23 / $410.27	Professional		$168.59	$229.23	$410.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $62.25 / $120.79	Professional	26	$51.30	$62.25	$120.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.85 / $166.98 / $299.10	Professional	TC	$111.85	$166.98	$299.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $160.72 / $205.54 / $339.81	Professional		$160.72	$205.54	$339.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.86 / $65.98 / $101.52	Professional	26	$52.86	$65.98	$101.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.86 / $137.94 / $232.47	Professional	TC	$107.86	$137.94	$232.47
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $242.36 / $282.80 / $1,042.31	Professional		$242.36	$282.80	$1,042.31
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $63.79 / $63.79 / $81.01	Professional	26	$63.79	$63.79	$81.01
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $167.11 / $219.01 / $278.14	Professional	TC	$167.11	$219.01	$278.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.34 / $66.34 / $66.34	Facility	26	$66.34	$66.34	$66.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $331.70 / $530.20	Professional		$147.91	$331.70	$530.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.03 / $75.45 / $137.26	Professional	26	$47.03	$75.45	$137.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.54 / $252.30 / $402.93	Professional	TC	$109.54	$252.30	$402.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.19 / $198.23 / $244.19	Professional		$165.19	$198.23	$244.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.80 / $63.99 / $77.62	Professional	26	$51.80	$63.99	$77.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $113.38 / $136.06 / $166.74	Professional	TC	$113.38	$136.06	$166.74
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $87.41 / $100.00 / $181.47	Facility	26	$87.41	$100.00	$181.47
Medcost Facility/Professional Professional Modifier Low / Median / High Price $80.12 / $249.00 / $468.00	Professional		$80.12	$249.00	$468.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $82.72 / $287.10 / $511.97	Professional		$82.72	$287.10	$511.97
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $61.57 / $81.61 / $129.22	Professional	26	$61.57	$81.61	$129.22
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $136.19 / $218.43 / $338.89	Professional	TC	$136.19	$218.43	$338.89
United Facility/Professional Professional Modifier Low / Median / High Price $158.65 / $271.20 / $463.43	Professional		$158.65	$271.20	$463.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.98 / $74.29 / $112.65	Professional	26	$44.98	$74.29	$112.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $108.98 / $199.53 / $371.39	Professional	TC	$108.98	$199.53	$371.39