Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.45 / $96.92 / $172.70	Facility	26	$54.45	$96.92	$172.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $156.47 / $176.32 / $364.65	Professional		$156.47	$176.32	$364.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.45 / $65.12 / $118.23	Professional	26	$54.45	$65.12	$118.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.16 / $117.06 / $220.00	Professional	TC	$98.16	$117.06	$220.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $150.28 / $192.18 / $317.73	Professional		$150.28	$192.18	$317.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.62 / $69.44 / $107.00	Professional	26	$55.62	$69.44	$107.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $94.65 / $121.04 / $200.11	Professional	TC	$94.65	$121.04	$200.11
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $225.84 / $268.57 / $763.47	Professional		$225.84	$268.57	$763.47
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $67.15 / $74.54 / $93.43	Professional	26	$67.15	$74.54	$93.43
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $146.63 / $201.42 / $255.80	Professional	TC	$146.63	$201.42	$255.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.79 / $69.79 / $69.79	Facility	26	$69.79	$69.79	$69.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.33 / $297.00 / $496.04	Professional		$141.33	$297.00	$496.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.51 / $80.34 / $143.63	Professional	26	$49.51	$80.34	$143.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.97 / $215.02 / $359.84	Professional	TC	$96.97	$215.02	$359.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $153.82 / $185.04 / $228.22	Professional		$153.82	$185.04	$228.22
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.53 / $67.36 / $81.67	Professional	26	$54.53	$67.36	$81.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $99.29 / $119.15 / $146.01	Professional	TC	$99.29	$119.15	$146.01
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $91.32 / $106.00 / $187.65	Facility	26	$91.32	$106.00	$187.65
Medcost Facility/Professional Professional Modifier Low / Median / High Price $84.32 / $247.00 / $466.00	Professional		$84.32	$247.00	$466.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $85.81 / $251.62 / $451.20	Professional		$85.81	$251.62	$451.20
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $64.02 / $85.45 / $135.29	Professional	26	$64.02	$85.45	$135.29
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $110.46 / $206.67 / $290.02	Professional	TC	$110.46	$206.67	$290.02
United Facility/Professional Professional Modifier Low / Median / High Price $155.49 / $265.73 / $430.20	Professional		$155.49	$265.73	$430.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.71 / $73.68 / $113.68	Professional	26	$43.71	$73.68	$113.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $108.19 / $183.94 / $323.92	Professional	TC	$108.19	$183.94	$323.92