Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.85 / $82.45 / $170.91	Facility	26	$47.85	$82.45	$170.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $150.53 / $171.00 / $353.25	Professional		$150.53	$171.00	$353.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.85 / $57.26 / $117.69	Professional	26	$47.85	$57.26	$117.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.79 / $116.69 / $261.63	Professional	TC	$98.79	$116.69	$261.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $143.82 / $183.92 / $306.41	Professional		$143.82	$183.92	$306.41
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.55 / $61.69 / $94.81	Professional	26	$48.55	$61.69	$94.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.27 / $121.83 / $217.67	Professional	TC	$95.27	$121.83	$217.67
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $216.66 / $235.30 / $881.82	Professional		$216.66	$235.30	$881.82
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $62.45 / $67.87 / $86.19	Professional	26	$62.45	$67.87	$86.19
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $147.59 / $167.43 / $212.64	Professional	TC	$147.59	$167.43	$212.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.98 / $60.98 / $60.98	Facility	26	$60.98	$60.98	$60.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $132.44 / $291.26 / $462.15	Professional		$132.44	$291.26	$462.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.54 / $74.72 / $133.22	Professional	26	$43.54	$74.72	$133.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.47 / $205.27 / $358.10	Professional	TC	$95.47	$205.27	$358.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.50 / $177.01 / $218.31	Professional		$147.50	$177.01	$218.31
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 $99.62 / $119.54 / $146.50	Professional	TC	$99.62	$119.54	$146.50
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $91.79 / $107.00 / $193.83	Facility	26	$91.79	$107.00	$193.83
Medcost Facility/Professional Professional Modifier Low / Median / High Price $76.00 / $206.00 / $456.00	Professional		$76.00	$206.00	$456.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $86.32 / $272.48 / $510.90	Professional		$86.32	$272.48	$510.90
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $57.02 / $80.88 / $125.19	Professional	26	$57.02	$80.88	$125.19
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $110.11 / $206.00 / $322.45	Professional	TC	$110.11	$206.00	$322.45
United Facility/Professional Professional Modifier Low / Median / High Price $134.62 / $222.12 / $410.47	Professional		$134.62	$222.12	$410.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.25 / $68.92 / $114.01	Professional	26	$42.25	$68.92	$114.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.67 / $156.93 / $319.95	Professional	TC	$88.67	$156.93	$319.95