Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.87 / $94.34 / $235.32	Facility	26	$73.87	$94.34	$235.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $201.34 / $359.08	Professional		$171.00	$201.34	$359.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.30 / $88.71 / $157.79	Professional	26	$71.30	$88.71	$157.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.66 / $117.43 / $217.42	Professional	TC	$101.66	$117.43	$217.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.02 / $215.39 / $365.80	Professional		$173.02	$215.39	$365.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $73.34 / $93.02 / $147.30	Professional	26	$73.34	$93.02	$147.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $98.03 / $123.82 / $207.27	Professional	TC	$98.03	$123.82	$207.27
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $258.58 / $278.50 / $2,145.54	Professional		$258.58	$278.50	$2,145.54
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $90.48 / $100.43 / $140.24	Professional	26	$90.48	$100.43	$140.24
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $151.87 / $188.02 / $291.43	Professional	TC	$151.87	$188.02	$291.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.97 / $275.14 / $495.30	Professional		$169.97	$275.14	$495.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.69 / $108.38 / $195.94	Professional	26	$66.69	$108.38	$195.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.84 / $159.96 / $277.58	Professional	TC	$96.84	$159.96	$277.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $176.68 / $213.84 / $263.74	Professional		$176.68	$213.84	$263.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $73.78 / $91.14 / $110.82	Professional	26	$73.78	$91.14	$110.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.89 / $123.47 / $151.31	Professional	TC	$102.89	$123.47	$151.31
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $122.67 / $142.44 / $277.00	Facility	26	$122.67	$142.44	$277.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $111.00 / $192.67 / $350.00	Professional		$111.00	$192.67	$350.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $106.34 / $241.49 / $448.16	Professional		$106.34	$241.49	$448.16
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $83.07 / $113.47 / $184.13	Professional	26	$83.07	$113.47	$184.13
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $112.96 / $164.23 / $248.36	Professional	TC	$112.96	$164.23	$248.36
United Facility/Professional Professional Modifier Low / Median / High Price $159.26 / $241.92 / $387.81	Professional		$159.26	$241.92	$387.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.56 / $104.11 / $160.81	Professional	26	$64.56	$104.11	$160.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.38 / $144.84 / $227.80	Professional	TC	$90.38	$144.84	$227.80