Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.81 / $74.42 / $2,888.00	Facility	26	$41.81	$74.42	$2,888.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.79 / $161.99 / $290.69	Professional		$102.79	$161.99	$290.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $51.15 / $100.30	Professional	26	$41.81	$51.15	$100.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.46 / $113.97 / $220.00	Professional	TC	$83.46	$113.97	$220.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.31 / $156.41 / $258.58	Professional		$122.31	$156.41	$258.58
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 $183.46 / $234.61 / $387.88	Professional	50	$183.46	$234.61	$387.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.28 / $101.39 / $173.62	Professional	TC	$79.28	$101.39	$173.62
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $184.06 / $225.43 / $764.34	Professional		$184.06	$225.43	$764.34
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.67 / $58.46 / $73.73	Professional	26	$52.67	$58.46	$73.73
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $122.83 / $172.76 / $219.41	Professional	TC	$122.83	$172.76	$219.41
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 $112.72 / $258.58 / $410.06	Professional		$112.72	$258.58	$410.06
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 $81.25 / $188.88 / $301.18	Professional	TC	$81.25	$188.88	$301.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.71 / $151.13 / $186.39	Professional		$125.71	$151.13	$186.39
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 $83.56 / $100.28 / $122.89	Professional	TC	$83.56	$100.28	$122.89
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $77.84 / $90.00 / $159.69	Facility	26	$77.84	$90.00	$159.69
Medcost Facility/Professional Professional Modifier Low / Median / High Price $64.97 / $201.89 / $375.00	Professional		$64.97	$201.89	$375.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $72.34 / $230.88 / $416.85	Professional		$72.34	$230.88	$416.85
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 $101.31 / $182.54 / $284.02	Professional	TC	$101.31	$182.54	$284.02
United Facility/Professional Professional Modifier Low / Median / High Price $124.86 / $202.89 / $378.84	Professional		$124.86	$202.89	$378.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.22 / $61.14 / $101.08	Professional	26	$39.22	$61.14	$101.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.04 / $148.46 / $293.05	Professional	TC	$83.04	$148.46	$293.05