Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.98 / $58.21 / $124.94	Facility	26	$31.98	$58.21	$124.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.69 / $138.74 / $281.37	Professional		$128.69	$138.74	$281.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.86 / $34.40 / $65.34	Professional	26	$30.86	$34.40	$65.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.24 / $104.76 / $218.69	Professional	TC	$96.24	$104.76	$218.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $132.88 / $168.51 / $238.24	Professional		$132.88	$168.51	$238.24
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.57 / $40.54 / $57.13	Professional	26	$32.57	$40.54	$57.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $101.01 / $128.35 / $181.10	Professional	TC	$101.01	$128.35	$181.10
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $169.29 / $169.29 / $313.73	Professional		$169.29	$169.29	$313.73
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $39.68 / $39.68 / $75.00	Professional	26	$39.68	$39.68	$75.00
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $129.60 / $129.60 / $244.94	Professional	TC	$129.60	$129.60	$244.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.92 / $40.92 / $40.92	Facility	26	$40.92	$40.92	$40.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.90 / $172.25 / $354.63	Professional		$115.90	$172.25	$354.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.71 / $44.22 / $82.21	Professional	26	$28.71	$44.22	$82.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.27 / $129.55 / $266.79	Professional	TC	$88.27	$129.55	$266.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $139.41 / $173.79 / $215.34	Professional		$139.41	$173.79	$215.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.22 / $40.94 / $50.62	Professional	26	$32.22	$40.94	$50.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $105.21 / $133.99 / $167.36	Professional	TC	$105.21	$133.99	$167.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $48.87 / $57.80 / $112.32	Facility	26	$48.87	$57.80	$112.32
Medcost Facility/Professional Professional Modifier Low / Median / High Price $48.00 / $166.00 / $263.76	Professional		$48.00	$166.00	$263.76
Sentara Facility/Professional Professional Modifier Low / Median / High Price $46.19 / $169.13 / $307.08	Professional		$46.19	$169.13	$307.08
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $50.44 / $80.79	Professional	26	$37.15	$50.44	$80.79
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $106.10 / $153.35 / $248.00	Professional	TC	$106.10	$153.35	$248.00
United Facility/Professional Professional Modifier Low / Median / High Price $108.94 / $166.11 / $270.14	Professional		$108.94	$166.11	$270.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.37 / $42.98 / $61.80	Professional	26	$27.37	$42.98	$61.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.14 / $117.07 / $208.34	Professional	TC	$77.14	$117.07	$208.34