Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $145.18 / $171.29 / $319.26	Facility	26	$145.18	$171.29	$319.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $224.29 / $267.70 / $434.78	Professional		$224.29	$267.70	$434.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $136.62 / $161.53 / $283.10	Professional	26	$136.62	$161.53	$283.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.48 / $105.83 / $165.56	Professional	TC	$85.48	$105.83	$165.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.49 / $276.88 / $436.27	Professional		$200.49	$276.88	$436.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.55 / $172.49 / $271.77	Professional	26	$123.55	$172.49	$271.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $77.77 / $104.16 / $164.49	Professional	TC	$77.77	$104.16	$164.49
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $219.08 / $243.42 / $474.67	Professional		$219.08	$243.42	$474.67
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $136.74 / $142.46 / $277.80	Professional	26	$136.74	$142.46	$277.80
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $100.96 / $100.96 / $196.87	Professional	TC	$100.96	$100.96	$196.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $217.08 / $340.36 / $588.30	Professional		$217.08	$340.36	$588.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $149.54 / $214.51 / $361.84	Professional	26	$149.54	$214.51	$361.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.11 / $135.58 / $228.40	Professional	TC	$89.11	$135.58	$228.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $226.70 / $278.05 / $346.72	Professional		$226.70	$278.05	$346.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $140.19 / $173.18 / $214.41	Professional	26	$140.19	$173.18	$214.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $86.44 / $101.78 / $132.31	Professional	TC	$86.44	$101.78	$132.31
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $209.50 / $339.95 / $421.83	Facility	26	$209.50	$339.95	$421.83
Medcost Facility/Professional Professional Modifier Low / Median / High Price $125.00 / $222.58 / $433.11	Professional		$125.00	$222.58	$433.11
Sentara Facility/Professional Professional Modifier Low / Median / High Price $127.88 / $294.17 / $547.78	Professional		$127.88	$294.17	$547.78
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $160.06 / $217.32 / $349.03	Professional	26	$160.06	$217.32	$349.03
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $102.30 / $143.54 / $228.64	Professional	TC	$102.30	$143.54	$228.64
United Facility/Professional Professional Modifier Low / Median / High Price $219.81 / $351.50 / $549.62	Professional		$219.81	$351.50	$549.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $131.08 / $221.29 / $322.74	Professional	26	$131.08	$221.29	$322.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.17 / $145.75 / $226.55	Professional	TC	$89.17	$145.75	$226.55