Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.85 / $85.17 / $186.93	Facility	26	$47.85	$85.17	$186.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $269.44 / $494.20	Professional		$171.00	$269.44	$494.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.85 / $69.08 / $125.19	Professional	26	$47.85	$69.08	$125.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.07 / $198.97 / $368.36	Professional	TC	$120.07	$198.97	$368.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $170.87 / $218.51 / $361.26	Professional		$170.87	$218.51	$361.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.86 / $62.49 / $95.66	Professional	26	$48.86	$62.49	$95.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $122.00 / $156.33 / $259.66	Professional	TC	$122.00	$156.33	$259.66
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $258.56 / $280.07 / $892.33	Professional		$258.56	$280.07	$892.33
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $65.93 / $71.92 / $91.34	Professional	26	$65.93	$71.92	$91.34
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $189.01 / $207.38 / $290.33	Professional	TC	$189.01	$207.38	$290.33
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 $157.60 / $343.69 / $562.02	Professional		$157.60	$343.69	$562.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.43 / $79.42 / $141.10	Professional	26	$44.43	$79.42	$141.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.01 / $264.31 / $435.46	Professional	TC	$125.01	$264.31	$435.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $175.69 / $210.82 / $258.82	Professional		$175.69	$210.82	$258.82
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 $127.81 / $153.37 / $187.95	Professional	TC	$127.81	$153.37	$187.95
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $98.79 / $114.00 / $198.80	Facility	26	$98.79	$114.00	$198.80
Medcost Facility/Professional Professional Modifier Low / Median / High Price $88.00 / $302.00 / $540.00	Professional		$88.00	$302.00	$540.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $91.22 / $316.16 / $594.29	Professional		$91.22	$316.16	$594.29
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $59.70 / $84.18 / $125.19	Professional	26	$59.70	$84.18	$125.19
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $157.44 / $266.68 / $389.65	Professional	TC	$157.44	$266.68	$389.65
United Facility/Professional Professional Modifier Low / Median / High Price $174.88 / $292.68 / $483.81	Professional		$174.88	$292.68	$483.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.52 / $68.92 / $111.45	Professional	26	$44.52	$68.92	$111.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.59 / $220.88 / $404.41	Professional	TC	$130.59	$220.88	$404.41