Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.36 / $73.44 / $140.82	Facility	26	$49.36	$73.44	$140.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $110.81 / $130.07 / $275.00	Professional		$110.81	$130.07	$275.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.26 / $49.36 / $71.67	Professional	26	$40.26	$49.36	$71.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.45 / $84.26 / $162.60	Professional	TC	$61.45	$84.26	$162.60
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.86 / $153.80 / $253.01	Professional		$120.86	$153.80	$253.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.18 / $51.37 / $80.61	Professional	26	$41.18	$51.37	$80.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $103.00 / $171.52	Professional	TC	$79.43	$103.00	$171.52
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $162.08 / $186.06 / $569.41	Professional		$162.08	$186.06	$569.41
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $50.80 / $50.80 / $64.52	Professional	26	$50.80	$50.80	$64.52
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $111.28 / $119.41 / $141.33	Professional	TC	$111.28	$119.41	$141.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.84 / $51.84 / $51.84	Facility	26	$51.84	$51.84	$51.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.78 / $212.88 / $357.93	Professional		$113.78	$212.88	$357.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $59.43 / $108.69	Professional	26	$36.54	$59.43	$108.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.57 / $148.34 / $241.79	Professional	TC	$82.57	$148.34	$241.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $126.76 / $152.16 / $187.68	Professional		$126.76	$152.16	$187.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.25 / $49.72 / $60.40	Professional	26	$40.25	$49.72	$60.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $86.51 / $103.82 / $127.23	Professional	TC	$86.51	$103.82	$127.23
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $70.11 / $95.00 / $144.81	Facility	26	$70.11	$95.00	$144.81
Medcost Facility/Professional Professional Modifier Low / Median / High Price $62.50 / $154.00 / $307.00	Professional		$62.50	$154.00	$307.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $64.70 / $178.41 / $297.81	Professional		$64.70	$178.41	$297.81
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $49.16 / $65.03 / $101.95	Professional	26	$49.16	$65.03	$101.95
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $84.99 / $144.38 / $194.84	Professional	TC	$84.99	$144.38	$194.84
United Facility/Professional Professional Modifier Low / Median / High Price $115.83 / $189.40 / $304.01	Professional		$115.83	$189.40	$304.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.51 / $58.99 / $99.12	Professional	26	$35.51	$58.99	$99.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.22 / $125.49 / $211.19	Professional	TC	$77.22	$125.49	$211.19