Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.83 / $80.41 / $183.91	Facility	26	$53.83	$80.41	$183.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $210.79 / $239.21 / $422.00	Professional		$210.79	$239.21	$422.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.83 / $64.76 / $127.10	Professional	26	$53.83	$64.76	$127.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.85 / $175.10 / $309.89	Professional	TC	$158.85	$175.10	$309.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $220.65 / $282.17 / $450.71	Professional		$220.65	$282.17	$450.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.01 / $68.68 / $106.00	Professional	26	$55.01	$68.68	$106.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $165.65 / $211.83 / $341.73	Professional	TC	$165.65	$211.83	$341.73
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $307.16 / $334.93 / $1,021.81	Professional		$307.16	$334.93	$1,021.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $66.39 / $78.04 / $92.05	Professional	26	$66.39	$78.04	$92.05
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $240.78 / $256.62 / $305.79	Professional	TC	$240.78	$256.62	$305.79
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 $199.95 / $363.65 / $612.02	Professional		$199.95	$363.65	$612.02
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 $154.78 / $284.66 / $461.35	Professional	TC	$154.78	$284.66	$461.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $225.30 / $270.36 / $331.33	Professional		$225.30	$270.36	$331.33
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 $171.39 / $205.67 / $252.05	Professional	TC	$171.39	$205.67	$252.05
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $86.36 / $135.00 / $212.00	Facility	26	$86.36	$135.00	$212.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $82.00 / $284.00 / $514.00	Professional		$82.00	$284.00	$514.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $86.73 / $350.76 / $602.85	Professional		$86.73	$350.76	$602.85
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $63.58 / $84.96 / $134.53	Professional	26	$63.58	$84.96	$134.53
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $178.37 / $292.54 / $419.56	Professional	TC	$178.37	$292.54	$419.56
United Facility/Professional Professional Modifier Low / Median / High Price $199.29 / $316.89 / $502.36	Professional		$199.29	$316.89	$502.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.72 / $79.09 / $117.88	Professional	26	$48.72	$79.09	$117.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.32 / $243.08 / $408.41	Professional	TC	$147.32	$243.08	$408.41