Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $204.17 / $323.59	Facility	26	$173.78	$204.17	$323.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $331.13 / $707.95	Professional		$257.04	$331.13	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $199.53 / $524.81	Professional	26	$165.96	$199.53	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $114.82 / $177.83	Professional	TC	$93.33	$114.82	$177.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $371.54 / $676.08	Professional		$269.15	$371.54	$676.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $234.42 / $426.58	Professional	26	$169.82	$234.42	$426.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $134.90 / $245.47	Professional	TC	$95.50	$134.90	$245.47
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $251.19 / $354.81	Professional		$112.20	$251.19	$354.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $169.82 / $234.42	Professional	26	$169.82	$169.82	$234.42
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $117.49 / $158.49	Professional	TC	$102.33	$117.49	$158.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $208.93 / $295.12	Facility	26	$44.67	$208.93	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $398.11 / $630.96	Professional		$275.42	$398.11	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $177.83 / $251.19 / $398.11	Professional	26	$177.83	$251.19	$398.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $151.36 / $239.88	Professional	TC	$100.00	$151.36	$239.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $338.84 / $436.52	Professional		$269.15	$338.84	$436.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $204.17 / $269.15	Professional	26	$165.96	$204.17	$269.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $131.83 / $165.96	Professional	TC	$107.15	$131.83	$165.96
Medcost Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $575.44 / $575.44	Professional		$575.44	$575.44	$575.44
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $346.74 / $346.74 / $346.74	Professional	26	$346.74	$346.74	$346.74
Medcost Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $309.03 / $309.03	Professional		$309.03	$309.03	$309.03
Sentara Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $309.03 / $645.65	Professional		$134.90	$309.03	$645.65
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $245.47 / $398.11	Professional	26	$181.97	$245.47	$398.11
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $147.91 / $251.19	Professional	TC	$109.65	$147.91	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $407.38 / $630.96	Professional		$257.04	$407.38	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $245.47 / $389.05	Professional	26	$154.88	$245.47	$389.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $154.88 / $239.88	Professional	TC	$97.72	$154.88	$239.88