Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.77 / $110.82 / $254.14	Facility	26	$93.77	$110.82	$254.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $230.90 / $284.98 / $433.26	Professional		$230.90	$284.98	$433.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.66 / $100.30 / $132.29	Professional	26	$82.66	$100.30	$132.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.21 / $181.44 / $298.05	Professional	TC	$141.21	$181.44	$298.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $238.50 / $338.23 / $519.24	Professional		$238.50	$338.23	$519.24
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $85.06 / $115.46 / $176.42	Professional	26	$85.06	$115.46	$176.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $154.09 / $223.53 / $342.82	Professional	TC	$154.09	$223.53	$342.82
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $287.77 / $316.56 / $561.16	Professional		$287.77	$316.56	$561.16
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $99.02 / $105.20 / $205.14	Professional	26	$99.02	$105.20	$205.14
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $182.58 / $182.58 / $356.03	Professional	TC	$182.58	$182.58	$356.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $230.75 / $386.61 / $685.53	Professional		$230.75	$386.61	$685.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.30 / $137.94 / $233.28	Professional	26	$96.30	$137.94	$233.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.49 / $242.91 / $434.47	Professional	TC	$97.49	$242.91	$434.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $278.04 / $333.08 / $425.23	Professional		$278.04	$333.08	$425.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $90.27 / $111.51 / $138.06	Professional	26	$90.27	$111.51	$138.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $187.59 / $220.90 / $287.17	Professional	TC	$187.59	$220.90	$287.17
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $101.44 / $133.00 / $262.95	Facility	26	$101.44	$133.00	$262.95
Medcost Facility/Professional Professional Modifier Low / Median / High Price $133.00 / $258.00 / $513.67	Professional		$133.00	$258.00	$513.67
Sentara Facility/Professional Professional Modifier Low / Median / High Price $119.36 / $323.12 / $590.91	Professional		$119.36	$323.12	$590.91
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $102.81 / $141.21 / $226.76	Professional	26	$102.81	$141.21	$226.76
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $175.91 / $285.64 / $398.95	Professional	TC	$175.91	$285.64	$398.95
United Facility/Professional Professional Modifier Low / Median / High Price $194.08 / $325.41 / $545.96	Professional		$194.08	$325.41	$545.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.61 / $138.81 / $208.86	Professional	26	$83.61	$138.81	$208.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.45 / $201.11 / $337.10	Professional	TC	$97.45	$201.11	$337.10