Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.04 / $81.95 / $179.32	Facility	26	$46.04	$81.95	$179.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.29 / $146.04 / $315.92	Professional		$131.29	$146.04	$315.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.04 / $55.17 / $97.94	Professional	26	$46.04	$55.17	$97.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.56 / $90.97 / $220.00	Professional	TC	$81.56	$90.97	$220.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.69 / $160.74 / $265.75	Professional		$125.69	$160.74	$265.75
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.02 / $58.62 / $90.46	Professional	26	$47.02	$58.62	$90.46
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.67 / $100.61 / $170.59	Professional	TC	$78.67	$100.61	$170.59
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $188.80 / $204.09 / $881.54	Professional		$188.80	$204.09	$881.54
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $56.34 / $62.54 / $74.14	Professional	26	$56.34	$62.54	$74.14
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $121.88 / $147.75 / $204.92	Professional	TC	$121.88	$147.75	$204.92
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.04 / $59.04 / $59.04	Facility	26	$59.04	$59.04	$59.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.97 / $262.52 / $435.00	Professional		$115.97	$262.52	$435.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.82 / $67.92 / $122.21	Professional	26	$41.82	$67.92	$122.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.20 / $168.84 / $315.61	Professional	TC	$79.20	$168.84	$315.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.65 / $154.91 / $191.07	Professional		$128.65	$154.91	$191.07
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.06 / $56.90 / $69.06	Professional	26	$46.06	$56.90	$69.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.59 / $99.10 / $121.45	Professional	TC	$82.59	$99.10	$121.45
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $78.34 / $115.65 / $165.00	Facility	26	$78.34	$115.65	$165.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $69.23 / $173.00 / $352.00	Professional		$69.23	$173.00	$352.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $73.48 / $208.37 / $400.00	Professional		$73.48	$208.37	$400.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $54.77 / $73.00 / $115.59	Professional	26	$54.77	$73.00	$115.59
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $89.69 / $143.86 / $243.20	Professional	TC	$89.69	$143.86	$243.20
United Facility/Professional Professional Modifier Low / Median / High Price $117.15 / $199.62 / $389.43	Professional		$117.15	$199.62	$389.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.64 / $66.33 / $100.70	Professional	26	$40.64	$66.33	$100.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.93 / $129.26 / $310.47	Professional	TC	$72.93	$129.26	$310.47