Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.22 / $75.05 / $172.43	Facility	26	$50.22	$75.05	$172.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.47 / $153.81 / $290.13	Professional		$134.47	$153.81	$290.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.22 / $60.81 / $117.98	Professional	26	$50.22	$60.81	$117.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $80.59 / $93.61 / $214.94	Professional	TC	$80.59	$93.61	$214.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.63 / $165.06 / $272.89	Professional		$128.63	$165.06	$272.89
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.90 / $64.06 / $98.56	Professional	26	$50.90	$64.06	$98.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $76.84 / $99.43 / $169.03	Professional	TC	$76.84	$99.43	$169.03
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $193.50 / $208.21 / $864.96	Professional		$193.50	$208.21	$864.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $62.31 / $69.16 / $81.68	Professional	26	$62.31	$69.16	$81.68
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $120.46 / $145.90 / $195.54	Professional	TC	$120.46	$145.90	$195.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.44 / $64.44 / $64.44	Facility	26	$64.44	$64.44	$64.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.24 / $263.30 / $412.56	Professional		$119.24	$263.30	$412.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.65 / $74.19 / $134.08	Professional	26	$45.65	$74.19	$134.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.95 / $166.19 / $307.97	Professional	TC	$77.95	$166.19	$307.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.55 / $158.81 / $195.86	Professional		$131.55	$158.81	$195.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.28 / $62.11 / $75.34	Professional	26	$50.28	$62.11	$75.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.27 / $97.52 / $119.51	Professional	TC	$81.27	$97.52	$119.51
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $85.80 / $125.81 / $198.00	Facility	26	$85.80	$125.81	$198.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $76.00 / $173.39 / $360.00	Professional		$76.00	$173.39	$360.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $79.14 / $243.83 / $442.87	Professional		$79.14	$243.83	$442.87
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $60.09 / $79.70 / $126.20	Professional	26	$60.09	$79.70	$126.20
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $88.29 / $166.79 / $271.60	Professional	TC	$88.29	$166.79	$271.60
United Facility/Professional Professional Modifier Low / Median / High Price $120.30 / $208.25 / $387.82	Professional		$120.30	$208.25	$387.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.36 / $71.23 / $110.27	Professional	26	$44.36	$71.23	$110.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.79 / $125.82 / $297.44	Professional	TC	$71.79	$125.82	$297.44