Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $85.11 / $213.80	Facility	26	$47.86	$85.11	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $234.42 / $602.56	Professional		$151.36	$234.42	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $87.10 / $218.78	Professional	26	$51.29	$87.10	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $134.90 / $371.54	Professional	TC	$100.00	$134.90	$371.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $213.80 / $346.74	Professional		$151.36	$213.80	$346.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $69.18 / $109.65	Professional	26	$51.29	$69.18	$109.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $141.25 / $234.42	Professional	TC	$100.00	$141.25	$234.42
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $218.78 / $977.24	Professional		$69.18	$218.78	$977.24
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $63.10 / $97.72	Professional	26	$58.88	$63.10	$97.72
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $147.91 / $208.93	Professional	TC	$131.83	$147.91	$208.93
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 $138.04 / $281.84 / $467.74	Professional		$138.04	$281.84	$467.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $72.44 / $131.83	Professional	26	$42.66	$72.44	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $204.17 / $354.81	Professional	TC	$91.20	$204.17	$354.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $177.83 / $223.87	Professional		$147.91	$177.83	$223.87
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 $97.72 / $120.23 / $154.88	Professional	TC	$97.72	$120.23	$154.88
Medcost Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $436.52 / $446.68	Professional		$354.81	$436.52	$446.68
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $114.82 / $114.82	Professional	26	$91.20	$114.82	$114.82
Medcost Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $257.04	Professional		$223.87	$223.87	$257.04
Sentara Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $239.88 / $741.31	Professional		$74.13	$239.88	$741.31
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $79.43 / $125.89	Professional	26	$54.95	$79.43	$125.89
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $204.17 / $338.84	Professional	TC	$107.15	$204.17	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $229.09 / $457.09	Professional		$134.90	$229.09	$457.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $64.57 / $114.82	Professional	26	$38.90	$64.57	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $162.18 / $363.08	Professional	TC	$89.13	$162.18	$363.08