Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.41 / $73.06 / $222.85	Facility	26	$51.41	$73.06	$222.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $167.27 / $227.81 / $422.00	Professional		$167.27	$227.81	$422.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $61.07 / $105.07	Professional	26	$51.30	$61.07	$105.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $110.89 / $165.56 / $281.81	Professional	TC	$110.89	$165.56	$281.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $159.50 / $204.37 / $337.22	Professional		$159.50	$204.37	$337.22
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.10 / $65.59 / $101.00	Professional	26	$52.10	$65.59	$101.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $106.94 / $139.30 / $232.08	Professional	TC	$106.94	$139.30	$232.08
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $240.47 / $282.80 / $1,041.42	Professional		$240.47	$282.80	$1,041.42
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $63.79 / $63.79 / $81.01	Professional	26	$63.79	$63.79	$81.01
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $165.68 / $219.01 / $278.14	Professional	TC	$165.68	$219.01	$278.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $65.98	Facility	26	$65.98	$65.98	$65.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $146.80 / $329.70 / $527.23	Professional		$146.80	$329.70	$527.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.74 / $75.45 / $137.26	Professional	26	$46.74	$75.45	$137.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $108.62 / $249.65 / $402.93	Professional	TC	$108.62	$249.65	$402.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $163.56 / $196.27 / $241.94	Professional		$163.56	$196.27	$241.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.48 / $63.60 / $77.11	Professional	26	$51.48	$63.60	$77.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.07 / $134.49 / $164.81	Professional	TC	$112.07	$134.49	$164.81
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $87.41 / $100.00 / $180.48	Facility	26	$87.41	$100.00	$180.48
Medcost Facility/Professional Professional Modifier Low / Median / High Price $79.73 / $248.00 / $468.00	Professional		$79.73	$248.00	$468.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $82.72 / $287.10 / $511.42	Professional		$82.72	$287.10	$511.42
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $61.57 / $81.61 / $129.22	Professional	26	$61.57	$81.61	$129.22
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $134.77 / $216.56 / $338.89	Professional	TC	$134.77	$216.56	$338.89
United Facility/Professional Professional Modifier Low / Median / High Price $157.50 / $269.19 / $469.29	Professional		$157.50	$269.19	$469.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.43 / $74.50 / $116.20	Professional	26	$45.43	$74.50	$116.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.84 / $181.71 / $383.73	Professional	TC	$107.84	$181.71	$383.73