Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.86 / $54.43 / $114.84	Facility	26	$35.86	$54.43	$114.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.66 / $119.70 / $275.00	Professional		$104.66	$119.70	$275.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.86 / $43.29 / $84.38	Professional	26	$35.86	$43.29	$84.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.95 / $76.48 / $220.00	Professional	TC	$65.95	$76.48	$220.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.18 / $128.12 / $211.82	Professional		$100.18	$128.12	$211.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.57 / $45.74 / $71.81	Professional	26	$36.57	$45.74	$71.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.61 / $81.34 / $141.68	Professional	TC	$63.61	$81.34	$141.68
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $150.59 / $162.51 / $701.28	Professional		$150.59	$162.51	$701.28
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $44.12 / $52.02 / $61.36	Professional	26	$44.12	$52.02	$61.36
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $98.56 / $118.39 / $183.50	Professional	TC	$98.56	$118.39	$183.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.92 / $45.92 / $45.92	Facility	26	$45.92	$45.92	$45.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.68 / $209.71 / $341.91	Professional		$92.68	$209.71	$341.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.52 / $52.90 / $99.30	Professional	26	$32.52	$52.90	$99.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.37 / $135.06 / $259.00	Professional	TC	$63.37	$135.06	$259.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $103.33 / $124.28 / $153.28	Professional		$103.33	$124.28	$153.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.15 / $44.66 / $53.81	Professional	26	$36.15	$44.66	$53.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $67.18 / $80.61 / $98.79	Professional	TC	$67.18	$80.61	$98.79
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $61.62 / $100.00 / $155.19	Facility	26	$61.62	$100.00	$155.19
Medcost Facility/Professional Professional Modifier Low / Median / High Price $55.64 / $143.00 / $298.00	Professional		$55.64	$143.00	$298.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $57.35 / $191.05 / $351.34	Professional		$57.35	$191.05	$351.34
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $42.88 / $57.25 / $90.65	Professional	26	$42.88	$57.25	$90.65
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $72.09 / $135.54 / $226.18	Professional	TC	$72.09	$135.54	$226.18
United Facility/Professional Professional Modifier Low / Median / High Price $93.06 / $165.67 / $337.52	Professional		$93.06	$165.67	$337.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.69 / $52.07 / $81.17	Professional	26	$30.69	$52.07	$81.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.89 / $103.61 / $248.03	Professional	TC	$58.89	$103.61	$248.03