Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.85 / $86.54 / $187.42	Facility	26	$47.85	$86.54	$187.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $146.25 / $164.16 / $349.73	Professional		$146.25	$164.16	$349.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.85 / $55.75 / $92.56	Professional	26	$47.85	$55.75	$92.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.97 / $106.22 / $225.45	Professional	TC	$93.97	$106.22	$225.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $140.13 / $179.21 / $296.27	Professional		$140.13	$179.21	$296.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.86 / $61.11 / $94.00	Professional	26	$48.86	$61.11	$94.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $91.27 / $116.72 / $194.85	Professional	TC	$91.27	$116.72	$194.85
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $210.96 / $226.05 / $856.48	Professional		$210.96	$226.05	$856.48
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.58 / $58.58 / $74.40	Professional	26	$58.58	$58.58	$74.40
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $141.41 / $167.47 / $212.69	Professional	TC	$141.41	$167.47	$212.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.11 / $274.02 / $438.94	Professional		$129.11	$274.02	$438.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.47 / $70.16 / $126.99	Professional	26	$43.47	$70.16	$126.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.64 / $192.10 / $330.68	Professional	TC	$90.64	$192.10	$330.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $143.90 / $172.81 / $213.13	Professional		$143.90	$172.81	$213.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.88 / $59.15 / $71.77	Professional	26	$47.88	$59.15	$71.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $96.02 / $115.22 / $141.19	Professional	TC	$96.02	$115.22	$141.19
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $80.94 / $94.00 / $167.73	Facility	26	$80.94	$94.00	$167.73
Medcost Facility/Professional Professional Modifier Low / Median / High Price $74.15 / $194.00 / $388.00	Professional		$74.15	$194.00	$388.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $75.88 / $235.30 / $423.66	Professional		$75.88	$235.30	$423.66
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $57.02 / $75.87 / $120.14	Professional	26	$57.02	$75.87	$120.14
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $103.62 / $166.08 / $260.73	Professional	TC	$103.62	$166.08	$260.73
United Facility/Professional Professional Modifier Low / Median / High Price $131.47 / $216.93 / $387.02	Professional		$131.47	$216.93	$387.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.93 / $68.68 / $107.54	Professional	26	$40.93	$68.68	$107.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.53 / $139.68 / $298.83	Professional	TC	$85.53	$139.68	$298.83