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 / $157.83	Facility	26	$41.81	$71.06	$157.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.66 / $161.99 / $317.66	Professional		$134.66	$161.99	$317.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $51.15 / $95.73	Professional	26	$41.81	$51.15	$95.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.93 / $112.36 / $220.00	Professional	TC	$101.93	$112.36	$220.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.71 / $194.93 / $322.27	Professional		$151.71	$194.93	$322.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.02 / $54.25 / $83.29	Professional	26	$43.02	$54.25	$83.29
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $225.78 / $287.70 / $483.41	Professional	50	$225.78	$287.70	$483.41
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.87 / $139.91 / $231.31	Professional	TC	$107.87	$139.91	$231.31
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $224.70 / $230.71 / $764.34	Professional		$224.70	$230.71	$764.34
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.67 / $52.67 / $66.89	Professional	26	$52.67	$52.67	$66.89
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $169.50 / $172.03 / $218.48	Professional	TC	$169.50	$172.03	$218.48
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 $139.93 / $272.29 / $442.30	Professional		$139.93	$272.29	$442.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.26 / $64.84 / $114.35	Professional	26	$38.26	$64.84	$114.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.01 / $202.67 / $330.71	Professional	TC	$112.01	$202.67	$330.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $156.51 / $187.81 / $230.55	Professional		$156.51	$187.81	$230.55
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 $114.37 / $137.24 / $168.19	Professional	TC	$114.37	$137.24	$168.19
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $77.84 / $90.00 / $161.40	Facility	26	$77.84	$90.00	$161.40
Medcost Facility/Professional Professional Modifier Low / Median / High Price $64.97 / $207.24 / $374.00	Professional		$64.97	$207.24	$374.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $72.37 / $227.46 / $402.25	Professional		$72.37	$227.46	$402.25
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $50.60 / $70.14 / $106.48	Professional	26	$50.60	$70.14	$106.48
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $110.46 / $175.51 / $258.35	Professional	TC	$110.46	$175.51	$258.35
United Facility/Professional Professional Modifier Low / Median / High Price $144.02 / $233.68 / $387.81	Professional		$144.02	$233.68	$387.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.19 / $59.96 / $92.61	Professional	26	$37.19	$59.96	$92.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.26 / $167.70 / $277.77	Professional	TC	$103.26	$167.70	$277.77