Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $155.65 / $285.75	Facility	26	$118.59	$155.65	$285.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $311.23 / $463.06 / $811.29	Professional		$311.23	$463.06	$811.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.33 / $126.00 / $172.40	Professional	26	$82.33	$126.00	$172.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $226.44 / $335.00 / $541.79	Professional	TC	$226.44	$335.00	$541.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $286.73 / $366.67 / $606.21	Professional		$286.73	$366.67	$606.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $73.95 / $90.69 / $144.09	Professional	26	$73.95	$90.69	$144.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $212.35 / $271.56 / $448.97	Professional	TC	$212.35	$271.56	$448.97
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $535.65 / $551.16 / $1,879.21	Professional		$535.65	$551.16	$1,879.21
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $87.30 / $93.65 / $117.06	Professional	26	$87.30	$93.65	$117.06
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $438.66 / $457.52 / $640.53	Professional	TC	$438.66	$457.52	$640.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $286.23 / $628.36 / $986.61	Professional		$286.23	$628.36	$986.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.13 / $108.01 / $195.15	Professional	26	$66.13	$108.01	$195.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $217.54 / $492.68 / $805.09	Professional	TC	$217.54	$492.68	$805.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $294.70 / $353.63 / $433.38	Professional		$294.70	$353.63	$433.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $73.17 / $90.38 / $109.91	Professional	26	$73.17	$90.38	$109.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $221.53 / $265.83 / $325.77	Professional	TC	$221.53	$265.83	$325.77
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $123.63 / $142.00 / $256.74	Facility	26	$123.63	$142.00	$256.74
Medcost Facility/Professional Professional Modifier Low / Median / High Price $113.46 / $537.00 / $959.00	Professional		$113.46	$537.00	$959.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $116.14 / $528.76 / $880.40	Professional		$116.14	$528.76	$880.40
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $87.42 / $116.35 / $184.23	Professional	26	$87.42	$116.35	$184.23
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $265.95 / $451.46 / $637.90	Professional	TC	$265.95	$451.46	$637.90
United Facility/Professional Professional Modifier Low / Median / High Price $283.42 / $467.65 / $876.12	Professional		$283.42	$467.65	$876.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.56 / $105.67 / $171.24	Professional	26	$64.56	$105.67	$171.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $213.90 / $398.55 / $718.47	Professional	TC	$213.90	$398.55	$718.47