Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.41 / $83.44 / $176.62	Facility	26	$51.41	$83.44	$176.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $167.60 / $228.17 / $409.01	Professional		$167.60	$228.17	$409.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.41 / $62.25 / $120.79	Professional	26	$51.41	$62.25	$120.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.21 / $165.92 / $297.83	Professional	TC	$111.21	$165.92	$297.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $159.80 / $204.76 / $337.86	Professional		$159.80	$204.76	$337.86
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 $107.25 / $139.30 / $231.77	Professional	TC	$107.25	$139.30	$231.77
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $240.94 / $282.06 / $1,041.42	Professional		$240.94	$282.06	$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 $166.15 / $218.27 / $277.20	Professional	TC	$166.15	$218.27	$277.20
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 $147.08 / $332.95 / $528.17	Professional		$147.08	$332.95	$528.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.74 / $75.98 / $139.82	Professional	26	$46.74	$75.98	$139.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.73 / $256.00 / $402.93	Professional	TC	$109.73	$256.00	$402.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $164.21 / $197.05 / $242.88	Professional		$164.21	$197.05	$242.88
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 $112.73 / $135.27 / $165.78	Professional	TC	$112.73	$135.27	$165.78
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $87.41 / $101.00 / $181.47	Facility	26	$87.41	$101.00	$181.47
Medcost Facility/Professional Professional Modifier Low / Median / High Price $79.73 / $248.00 / $467.00	Professional		$79.73	$248.00	$467.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $82.72 / $286.24 / $511.42	Professional		$82.72	$286.24	$511.42
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $61.58 / $81.61 / $129.22	Professional	26	$61.58	$81.61	$129.22
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $135.13 / $217.04 / $338.89	Professional	TC	$135.13	$217.04	$338.89
United Facility/Professional Professional Modifier Low / Median / High Price $157.79 / $260.36 / $466.01	Professional		$157.79	$260.36	$466.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.56 / $72.91 / $112.39	Professional	26	$46.56	$72.91	$112.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $108.13 / $182.20 / $371.38	Professional	TC	$108.13	$182.20	$371.38