Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.81 / $73.03 / $152.91	Facility	26	$41.81	$73.03	$152.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.04 / $171.00 / $349.05	Professional		$128.04	$171.00	$349.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $54.38 / $106.98	Professional	26	$41.81	$54.38	$106.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.83 / $110.84 / $221.14	Professional	TC	$82.83	$110.84	$221.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.93 / $157.19 / $259.89	Professional		$122.93	$157.19	$259.89
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.02 / $54.84 / $84.23	Professional	26	$43.02	$54.84	$84.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.90 / $102.18 / $177.14	Professional	TC	$79.90	$102.18	$177.14
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $185.00 / $229.93 / $891.04	Professional		$185.00	$229.93	$891.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $55.22 / $61.22 / $85.59	Professional	26	$55.22	$61.22	$85.59
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $123.79 / $174.71 / $270.80	Professional	TC	$123.79	$174.71	$270.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.27 / $279.27 / $428.49	Professional		$113.27	$279.27	$428.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.26 / $67.27 / $121.78	Professional	26	$38.26	$67.27	$121.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.88 / $199.03 / $335.95	Professional	TC	$81.88	$199.03	$335.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $126.04 / $151.50 / $186.85	Professional		$126.04	$151.50	$186.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.14 / $52.06 / $62.71	Professional	26	$42.14	$52.06	$62.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.90 / $100.67 / $123.38	Professional	TC	$83.90	$100.67	$123.38
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $58.31 / $112.00 / $171.99	Facility	26	$58.31	$112.00	$171.99
Medcost Facility/Professional Professional Modifier Low / Median / High Price $68.00 / $202.40 / $396.00	Professional		$68.00	$202.40	$396.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $75.01 / $250.32 / $436.22	Professional		$75.01	$250.32	$436.22
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $51.80 / $71.06 / $106.48	Professional	26	$51.80	$71.06	$106.48
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $102.10 / $193.92 / $288.56	Professional	TC	$102.10	$193.92	$288.56
United Facility/Professional Professional Modifier Low / Median / High Price $125.42 / $214.57 / $394.24	Professional		$125.42	$214.57	$394.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.04 / $61.14 / $101.08	Professional	26	$37.04	$61.14	$101.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.66 / $149.47 / $310.47	Professional	TC	$84.66	$149.47	$310.47