Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.87 / $100.07 / $188.87	Facility	26	$58.87	$100.07	$188.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $215.94 / $270.16 / $451.73	Professional		$215.94	$270.16	$451.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.06 / $71.20 / $125.52	Professional	26	$55.06	$71.20	$125.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.15 / $198.97 / $361.33	Professional	TC	$159.15	$198.97	$361.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $244.90 / $313.27 / $486.98	Professional		$244.90	$313.27	$486.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.23 / $75.20 / $116.53	Professional	26	$60.23	$75.20	$116.53
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $183.69 / $236.27 / $376.26	Professional	TC	$183.69	$236.27	$376.26
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $369.22 / $376.61 / $1,240.23	Professional		$369.22	$376.61	$1,240.23
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $73.45 / $81.53 / $95.50	Professional	26	$73.45	$81.53	$95.50
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $290.89 / $295.77 / $375.63	Professional	TC	$290.89	$295.77	$375.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.64 / $75.64 / $75.64	Facility	26	$75.64	$75.64	$75.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $226.68 / $425.44 / $731.47	Professional		$226.68	$425.44	$731.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.57 / $87.08 / $160.71	Professional	26	$53.57	$87.08	$160.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $174.32 / $338.85 / $564.04	Professional	TC	$174.32	$338.85	$564.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $253.33 / $304.00 / $372.55	Professional		$253.33	$304.00	$372.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.00 / $72.88 / $88.31	Professional	26	$59.00	$72.88	$88.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $194.34 / $233.20 / $285.79	Professional	TC	$194.34	$233.20	$285.79
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $100.34 / $148.16 / $240.00	Facility	26	$100.34	$148.16	$240.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $90.00 / $323.00 / $647.00	Professional		$90.00	$323.00	$647.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $95.06 / $392.24 / $707.64	Professional		$95.06	$392.24	$707.64
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $69.64 / $93.52 / $148.08	Professional	26	$69.64	$93.52	$148.08
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $181.40 / $335.57 / $507.78	Professional	TC	$181.40	$335.57	$507.78
United Facility/Professional Professional Modifier Low / Median / High Price $224.71 / $365.16 / $622.15	Professional		$224.71	$365.16	$622.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.06 / $85.65 / $129.25	Professional	26	$52.06	$85.65	$129.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $167.61 / $276.17 / $501.86	Professional	TC	$167.61	$276.17	$501.86