Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $121.16 / $143.87 / $270.25	Facility	26	$121.16	$143.87	$270.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.70 / $240.87 / $386.78	Professional		$195.70	$240.87	$386.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.15 / $138.21 / $237.47	Professional	26	$115.15	$138.21	$237.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.06 / $96.25 / $151.94	Professional	TC	$78.06	$96.25	$151.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $171.50 / $236.85 / $373.19	Professional		$171.50	$236.85	$373.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.38 / $144.43 / $227.57	Professional	26	$102.38	$144.43	$227.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.14 / $92.36 / $145.62	Professional	TC	$69.14	$92.36	$145.62
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $188.00 / $208.89 / $407.34	Professional		$188.00	$208.89	$407.34
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $113.69 / $119.65 / $233.32	Professional	26	$113.69	$119.65	$233.32
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $89.24 / $89.24 / $174.02	Professional	TC	$89.24	$89.24	$174.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.46 / $292.08 / $507.97	Professional		$185.46	$292.08	$507.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $124.89 / $178.91 / $302.45	Professional	26	$124.89	$178.91	$302.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.01 / $122.05 / $211.86	Professional	TC	$79.01	$122.05	$211.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.83 / $238.73 / $297.97	Professional		$194.83	$238.73	$297.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $117.16 / $144.72 / $179.19	Professional	26	$117.16	$144.72	$179.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $77.55 / $91.37 / $118.78	Professional	TC	$77.55	$91.37	$118.78
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $175.04 / $284.58 / $354.31	Facility	26	$175.04	$284.58	$354.31
Medcost Facility/Professional Professional Modifier Low / Median / High Price $124.22 / $192.00 / $370.28	Professional		$124.22	$192.00	$370.28
Sentara Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $251.19 / $480.00	Professional		$114.82	$251.19	$480.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $133.47 / $181.66 / $291.66	Professional	26	$133.47	$181.66	$291.66
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $90.41 / $128.38 / $207.58	Professional	TC	$90.41	$128.38	$207.58
United Facility/Professional Professional Modifier Low / Median / High Price $188.05 / $308.20 / $464.00	Professional		$188.05	$308.20	$464.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.43 / $182.34 / $269.25	Professional	26	$109.43	$182.34	$269.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.89 / $132.71 / $208.82	Professional	TC	$77.89	$132.71	$208.82