Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $87.10 / $213.80	Facility	26	$47.86	$87.10	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $269.15 / $602.56	Professional		$173.78	$269.15	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $91.20 / $229.09	Professional	26	$52.48	$91.20	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $190.55 / $407.38	Professional	TC	$123.03	$190.55	$407.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $251.19 / $416.87	Professional		$177.83	$251.19	$416.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $69.18 / $112.20	Professional	26	$51.29	$69.18	$112.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $177.83 / $295.12	Professional	TC	$128.82	$177.83	$295.12
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $257.04 / $912.01	Professional		$63.10	$257.04	$912.01
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $69.18 / $104.71	Professional	26	$58.88	$69.18	$104.71
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $194.98 / $263.03	Professional	TC	$190.55	$194.98	$263.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $60.26 / $87.10	Facility	26	$13.18	$60.26	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $338.84 / $549.54	Professional		$169.82	$338.84	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $77.62 / $134.90	Professional	26	$43.65	$77.62	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $251.19 / $426.58	Professional	TC	$125.89	$251.19	$426.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $213.80 / $269.15	Professional		$177.83	$213.80	$269.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $58.88 / $75.86	Professional	26	$47.86	$58.88	$75.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $154.88 / $199.53	Professional	TC	$125.89	$154.88	$199.53
Medcost Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $436.52 / $457.09	Professional		$363.08	$436.52	$457.09
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $114.82 / $120.23	Professional	26	$97.72	$114.82	$120.23
Medcost Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $309.03	Professional		$223.87	$223.87	$309.03
Sentara Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $288.40 / $891.25	Professional		$81.28	$288.40	$891.25
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $128.82	Professional	26	$54.95	$83.18	$128.82
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $257.04 / $389.05	Professional	TC	$138.04	$257.04	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $281.84 / $524.81	Professional		$173.78	$281.84	$524.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $67.61 / $114.82	Professional	26	$40.74	$67.61	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $218.78 / $407.38	Professional	TC	$125.89	$218.78	$407.38