Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.75 / $52.79 / $143.54	Facility	26	$45.75	$52.79	$143.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.40 / $149.97 / $256.50	Professional		$134.40	$149.97	$256.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.76 / $52.79 / $89.19	Professional	26	$45.76	$52.79	$89.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.24 / $97.18 / $154.18	Professional	TC	$85.24	$97.18	$154.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $129.00 / $162.58 / $249.58	Professional		$129.00	$162.58	$249.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.16 / $58.15 / $89.61	Professional	26	$46.16	$58.15	$89.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.28 / $106.13 / $159.88	Professional	TC	$83.28	$106.13	$159.88
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $195.50 / $249.78 / $312.23	Professional		$195.50	$249.78	$312.23
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $66.48 / $79.93 / $101.51	Professional	26	$66.48	$79.93	$101.51
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $129.01 / $169.85 / $215.71	Professional	TC	$129.01	$169.85	$215.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $126.78 / $202.48 / $351.34	Professional		$126.78	$202.48	$351.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.56 / $67.47 / $114.30	Professional	26	$41.56	$67.47	$114.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.09 / $129.12 / $225.97	Professional	TC	$78.09	$129.12	$225.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $133.26 / $159.91 / $195.98	Professional		$133.26	$159.91	$195.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.77 / $54.93 / $68.09	Professional	26	$45.77	$54.93	$68.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.49 / $104.99 / $128.66	Professional	TC	$87.49	$104.99	$128.66
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $59.93 / $75.54 / $137.11	Facility	26	$59.93	$75.54	$137.11
Medcost Facility/Professional Professional Modifier Low / Median / High Price $89.88 / $165.00 / $264.00	Professional		$89.88	$165.00	$264.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $64.30 / $173.94 / $281.94	Professional		$64.30	$173.94	$281.94
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $51.37 / $71.63 / $113.20	Professional	26	$51.37	$71.63	$113.20
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $92.52 / $132.88 / $211.37	Professional	TC	$92.52	$132.88	$211.37
United Facility/Professional Professional Modifier Low / Median / High Price $117.61 / $188.17 / $299.39	Professional		$117.61	$188.17	$299.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.72 / $65.04 / $107.65	Professional	26	$40.72	$65.04	$107.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.95 / $123.13 / $200.74	Professional	TC	$79.95	$123.13	$200.74