Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.03 / $74.45 / $157.50	Facility	26	$49.03	$74.45	$157.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.22 / $226.36 / $404.48	Professional		$158.22	$226.36	$404.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.03 / $59.38 / $115.63	Professional	26	$49.03	$59.38	$115.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.53 / $166.98 / $298.47	Professional	TC	$111.53	$166.98	$298.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $157.65 / $201.61 / $333.32	Professional		$157.65	$201.61	$333.32
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 $107.56 / $137.55 / $229.62	Professional	TC	$107.56	$137.55	$229.62
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $237.92 / $280.50 / $891.04	Professional		$237.92	$280.50	$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 $166.63 / $219.67 / $278.98	Professional	TC	$166.63	$219.67	$278.98
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 $145.00 / $314.17 / $501.89	Professional		$145.00	$314.17	$501.89
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 $110.20 / $236.16 / $367.52	Professional	TC	$110.20	$236.16	$367.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $161.81 / $194.17 / $239.06	Professional		$161.81	$194.17	$239.06
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 $112.73 / $135.27 / $165.78	Professional	TC	$112.73	$135.27	$165.78
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $83.78 / $95.00 / $197.20	Facility	26	$83.78	$95.00	$197.20
Medcost Facility/Professional Professional Modifier Low / Median / High Price $76.01 / $247.00 / $451.00	Professional		$76.01	$247.00	$451.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $78.44 / $284.41 / $501.79	Professional		$78.44	$284.41	$501.79
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $58.09 / $77.78 / $123.16	Professional	26	$58.09	$77.78	$123.16
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $136.19 / $247.89 / $357.97	Professional	TC	$136.19	$247.89	$357.97
United Facility/Professional Professional Modifier Low / Median / High Price $156.08 / $253.63 / $452.88	Professional		$156.08	$253.63	$452.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.19 / $70.64 / $106.54	Professional	26	$43.19	$70.64	$106.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $108.98 / $207.30 / $334.65	Professional	TC	$108.98	$207.30	$334.65