Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $63.10 / $229.09	Facility	26	$30.90	$63.10	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $147.91 / $323.59	Professional		$97.72	$147.91	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $38.02 / $109.65	Professional	26	$28.18	$38.02	$109.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $112.20 / $218.78	Professional	TC	$91.20	$112.20	$218.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $194.98 / $288.40	Professional		$138.04	$194.98	$288.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $46.77 / $69.18	Professional	26	$34.67	$46.77	$69.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $147.91 / $218.78	Professional	TC	$102.33	$147.91	$218.78
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $165.96 / $288.40	Professional		$57.54	$165.96	$288.40
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $38.02 / $42.66	Professional	26	$33.88	$38.02	$42.66
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $128.82 / $158.49	Professional	TC	$114.82	$128.82	$158.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.71 / $40.74 / $58.88	Facility	26	$8.71	$40.74	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $173.78 / $331.13	Professional		$117.49	$173.78	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $43.65 / $77.62	Professional	26	$28.84	$43.65	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $128.82 / $251.19	Professional	TC	$89.13	$128.82	$251.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $165.96 / $208.93	Professional		$131.83	$165.96	$208.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $38.02 / $47.86	Professional	26	$30.20	$38.02	$47.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $128.82 / $158.49	Professional	TC	$102.33	$128.82	$158.49
Medcost Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $269.15 / $269.15	Professional		$213.80	$269.15	$269.15
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $66.07	Professional	26	$52.48	$66.07	$66.07
Medcost Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $245.47	Professional		$125.89	$125.89	$245.47
Sentara Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $158.49 / $323.59	Professional		$44.67	$158.49	$323.59
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $48.98 / $75.86	Professional	26	$37.15	$48.98	$75.86
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $147.91 / $239.88	Professional	TC	$107.15	$147.91	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $154.88 / $269.15	Professional		$109.65	$154.88	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $38.90 / $64.57	Professional	26	$27.54	$38.90	$64.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $117.49 / $204.17	Professional	TC	$79.43	$117.49	$204.17