Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.81 / $71.06 / $165.44	Facility	26	$41.81	$71.06	$165.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.38 / $167.73 / $351.08	Professional		$127.38	$167.73	$351.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $51.15 / $110.30	Professional	26	$41.81	$51.15	$110.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.87 / $110.84 / $221.14	Professional	TC	$81.87	$110.84	$221.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.00 / $156.02 / $257.94	Professional		$122.00	$156.02	$257.94
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 $78.98 / $101.00 / $176.14	Professional	TC	$78.98	$101.00	$176.14
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $183.58 / $225.47 / $891.04	Professional		$183.58	$225.47	$891.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $51.90 / $57.61 / $76.70	Professional	26	$51.90	$57.61	$76.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $122.36 / $173.57 / $220.43	Professional	TC	$122.36	$173.57	$220.43
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 $112.44 / $276.08 / $426.86	Professional		$112.44	$276.08	$426.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.26 / $66.14 / $121.78	Professional	26	$38.26	$66.14	$121.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.94 / $197.68 / $334.25	Professional	TC	$80.94	$197.68	$334.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.38 / $150.74 / $185.92	Professional		$125.38	$150.74	$185.92
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 $83.24 / $99.89 / $122.41	Professional	TC	$83.24	$99.89	$122.41
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $59.19 / $96.00 / $171.99	Facility	26	$59.19	$96.00	$171.99
Medcost Facility/Professional Professional Modifier Low / Median / High Price $64.97 / $201.38 / $390.00	Professional		$64.97	$201.38	$390.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $75.01 / $246.27 / $434.98	Professional		$75.01	$246.27	$434.98
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 $101.31 / $193.55 / $288.56	Professional	TC	$101.31	$193.55	$288.56
United Facility/Professional Professional Modifier Low / Median / High Price $124.86 / $214.57 / $394.24	Professional		$124.86	$214.57	$394.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.35 / $61.14 / $101.85	Professional	26	$38.35	$61.14	$101.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.96 / $148.46 / $310.47	Professional	TC	$81.96	$148.46	$310.47