Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.66 / $50.31 / $203.80	Facility	26	$46.66	$50.31	$203.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $172.08 / $203.65 / $245.27	Professional		$172.08	$203.65	$245.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.06 / $49.21 / $51.55	Professional	26	$42.06	$49.21	$51.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $127.60 / $157.00 / $172.67	Professional	TC	$127.60	$157.00	$172.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.39 / $242.88 / $395.32	Professional		$186.39	$242.88	$395.32
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.60 / $59.85 / $91.49	Professional	26	$46.60	$59.85	$91.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $139.80 / $182.75 / $302.14	Professional	TC	$139.80	$182.75	$302.14
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $283.02 / $283.55 / $592.54	Professional		$283.02	$283.55	$592.54
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $62.16 / $62.39 / $79.23	Professional	26	$62.16	$62.39	$79.23
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $220.63 / $220.63 / $280.20	Professional	TC	$220.63	$220.63	$280.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.80 / $59.80 / $59.80	Facility	26	$59.80	$59.80	$59.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.47 / $306.61 / $575.05	Professional		$190.47	$306.61	$575.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.38 / $68.81 / $116.56	Professional	26	$42.38	$68.81	$116.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.35 / $228.18 / $399.88	Professional	TC	$138.35	$228.18	$399.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.80 / $233.76 / $286.48	Professional		$194.80	$233.76	$286.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.68 / $56.02 / $69.44	Professional	26	$46.68	$56.02	$69.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $148.12 / $177.75 / $217.83	Professional	TC	$148.12	$177.75	$217.83
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $61.11 / $82.86 / $151.91	Facility	26	$61.11	$82.86	$151.91
Medcost Facility/Professional Professional Modifier Low / Median / High Price $91.65 / $283.00 / $424.00	Professional		$91.65	$283.00	$424.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $74.06 / $277.31 / $435.04	Professional		$74.06	$277.31	$435.04
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $56.54 / $74.06 / $117.09	Professional	26	$56.54	$74.06	$117.09
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $180.49 / $239.23 / $381.57	Professional	TC	$180.49	$239.23	$381.57
United Facility/Professional Professional Modifier Low / Median / High Price $168.53 / $280.88 / $471.94	Professional		$168.53	$280.88	$471.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.19 / $66.68 / $107.66	Professional	26	$41.19	$66.68	$107.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $136.25 / $212.83 / $355.54	Professional	TC	$136.25	$212.83	$355.54