Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.03 / $87.27 / $168.26	Facility	26	$49.03	$87.27	$168.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $185.86 / $223.52 / $422.00	Professional		$185.86	$223.52	$422.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.03 / $59.38 / $106.00	Professional	26	$49.03	$59.38	$106.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.57 / $164.14 / $292.75	Professional	TC	$138.57	$164.14	$292.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $189.92 / $242.87 / $398.42	Professional		$189.92	$242.87	$398.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.09 / $62.65 / $96.21	Professional	26	$50.09	$62.65	$96.21
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $139.83 / $178.82 / $295.64	Professional	TC	$139.83	$178.82	$295.64
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $276.83 / $287.93 / $891.04	Professional		$276.83	$287.93	$891.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $60.83 / $60.83 / $77.25	Professional	26	$60.83	$60.83	$77.25
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $204.55 / $216.00 / $274.32	Professional	TC	$204.55	$216.00	$274.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $174.16 / $324.82 / $550.50	Professional		$174.16	$324.82	$550.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.56 / $72.40 / $133.09	Professional	26	$44.56	$72.40	$133.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $143.16 / $251.83 / $422.74	Professional	TC	$143.16	$251.83	$422.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.91 / $233.90 / $286.64	Professional		$194.91	$233.90	$286.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $60.63 / $73.55	Professional	26	$49.08	$60.63	$73.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $145.83 / $174.99 / $214.45	Professional	TC	$145.83	$174.99	$214.45
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $83.03 / $96.00 / $171.99	Facility	26	$83.03	$96.00	$171.99
Medcost Facility/Professional Professional Modifier Low / Median / High Price $76.00 / $273.00 / $465.00	Professional		$76.00	$273.00	$465.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $79.02 / $294.74 / $520.62	Professional		$79.02	$294.74	$520.62
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $58.16 / $77.78 / $123.16	Professional	26	$58.16	$77.78	$123.16
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $162.19 / $242.88 / $368.95	Professional	TC	$162.19	$242.88	$368.95
United Facility/Professional Professional Modifier Low / Median / High Price $179.26 / $282.52 / $456.97	Professional		$179.26	$282.52	$456.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.31 / $69.08 / $106.61	Professional	26	$43.31	$69.08	$106.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.16 / $218.06 / $359.81	Professional	TC	$132.16	$218.06	$359.81