Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.45 / $92.56 / $172.70	Facility	26	$54.45	$92.56	$172.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $171.00 / $316.32	Professional		$147.91	$171.00	$316.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.52 / $65.12 / $116.94	Professional	26	$52.52	$65.12	$116.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.52 / $110.06 / $220.00	Professional	TC	$89.52	$110.06	$220.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.66 / $181.17 / $299.52	Professional		$141.66	$181.17	$299.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.31 / $69.06 / $107.00	Professional	26	$55.31	$69.06	$107.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $86.35 / $110.43 / $183.97	Professional	TC	$86.35	$110.43	$183.97
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $212.52 / $237.37 / $763.47	Professional		$212.52	$237.37	$763.47
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $66.75 / $66.75 / $84.77	Professional	26	$66.75	$66.75	$84.77
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $133.79 / $170.63 / $216.70	Professional	TC	$133.79	$170.63	$216.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.44 / $69.44 / $69.44	Facility	26	$69.44	$69.44	$69.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $130.82 / $271.64 / $434.85	Professional		$130.82	$271.64	$434.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.21 / $79.91 / $144.41	Professional	26	$49.21	$79.91	$144.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.63 / $186.07 / $294.95	Professional	TC	$87.63	$186.07	$294.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.97 / $174.83 / $215.62	Professional		$144.97	$174.83	$215.62
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 $90.45 / $108.54 / $133.01	Professional	TC	$90.45	$108.54	$133.01
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $91.80 / $105.00 / $188.62	Facility	26	$91.80	$105.00	$188.62
Medcost Facility/Professional Professional Modifier Low / Median / High Price $84.32 / $197.00 / $387.00	Professional		$84.32	$197.00	$387.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $86.25 / $227.81 / $414.23	Professional		$86.25	$227.81	$414.23
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $63.93 / $85.45 / $135.29	Professional	26	$63.93	$85.45	$135.29
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $101.70 / $158.55 / $248.05	Professional	TC	$101.70	$158.55	$248.05
United Facility/Professional Professional Modifier Low / Median / High Price $132.62 / $218.83 / $378.83	Professional		$132.62	$218.83	$378.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.11 / $78.39 / $130.68	Professional	26	$49.11	$78.39	$130.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.36 / $141.33 / $257.12	Professional	TC	$80.36	$141.33	$257.12