Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.81 / $74.42 / $152.91	Facility	26	$41.81	$74.42	$152.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.04 / $165.62 / $335.50	Professional		$128.04	$165.62	$335.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $51.15 / $106.98	Professional	26	$41.81	$51.15	$106.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.51 / $110.84 / $221.14	Professional	TC	$82.51	$110.84	$221.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.62 / $156.81 / $259.25	Professional		$122.62	$156.81	$259.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.02 / $54.14 / $84.22	Professional	26	$43.02	$54.14	$84.22
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.59 / $101.79 / $176.47	Professional	TC	$79.59	$101.79	$176.47
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $184.54 / $226.58 / $891.04	Professional		$184.54	$226.58	$891.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $51.90 / $55.48 / $65.91	Professional	26	$51.90	$55.48	$65.91
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $123.31 / $174.68 / $221.84	Professional	TC	$123.31	$174.68	$221.84
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 $112.99 / $276.77 / $427.40	Professional		$112.99	$276.77	$427.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.26 / $66.05 / $118.17	Professional	26	$38.26	$66.05	$118.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.84 / $196.00 / $332.07	Professional	TC	$80.84	$196.00	$332.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.71 / $151.13 / $186.39	Professional		$125.71	$151.13	$186.39
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 $83.56 / $100.28 / $122.89	Professional	TC	$83.56	$100.28	$122.89
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $83.78 / $95.00 / $171.99	Facility	26	$83.78	$95.00	$171.99
Medcost Facility/Professional Professional Modifier Low / Median / High Price $64.97 / $202.40 / $391.00	Professional		$64.97	$202.40	$391.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $75.01 / $210.61 / $399.18	Professional		$75.01	$210.61	$399.18
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $50.60 / $70.19 / $106.48	Professional	26	$50.60	$70.19	$106.48
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $101.70 / $155.60 / $256.07	Professional	TC	$101.70	$155.60	$256.07
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 $38.22 / $61.14 / $95.36	Professional	26	$38.22	$61.14	$95.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.61 / $150.02 / $310.47	Professional	TC	$83.61	$150.02	$310.47