Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.85 / $74.48 / $164.26	Facility	26	$41.85	$74.48	$164.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.06 / $129.90 / $238.60	Professional		$104.06	$129.90	$238.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.85 / $45.25 / $96.15	Professional	26	$41.85	$45.25	$96.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.72 / $73.44 / $138.04	Professional	TC	$61.72	$73.44	$138.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.18 / $135.93 / $189.73	Professional		$108.18	$135.93	$189.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.72 / $53.48 / $74.92	Professional	26	$42.72	$53.48	$74.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.45 / $82.37 / $114.80	Professional	TC	$65.45	$82.37	$114.80
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $138.38 / $138.38 / $448.10	Professional		$138.38	$138.38	$448.10
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.00 / $52.00 / $98.28	Professional	26	$52.00	$52.00	$98.28
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $86.39 / $86.39 / $163.28	Professional	TC	$86.39	$86.39	$163.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.62 / $53.62 / $53.62	Facility	26	$53.62	$53.62	$53.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.46 / $155.94 / $280.51	Professional		$94.46	$155.94	$280.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.75 / $60.83 / $111.86	Professional	26	$37.75	$60.83	$111.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.43 / $94.20 / $175.76	Professional	TC	$56.43	$94.20	$175.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $110.67 / $136.71 / $168.43	Professional		$110.67	$136.71	$168.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.19 / $53.60 / $66.36	Professional	26	$42.19	$53.60	$66.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.45 / $84.61 / $105.65	Professional	TC	$66.45	$84.61	$105.65
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $70.64 / $83.00 / $133.54	Facility	26	$70.64	$83.00	$133.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $64.97 / $114.59 / $207.94	Professional		$64.97	$114.59	$207.94
Sentara Facility/Professional Professional Modifier Low / Median / High Price $61.23 / $146.63 / $278.77	Professional		$61.23	$146.63	$278.77
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $50.59 / $66.44 / $105.80	Professional	26	$50.59	$66.44	$105.80
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $74.97 / $106.80 / $163.04	Professional	TC	$74.97	$106.80	$163.04
United Facility/Professional Professional Modifier Low / Median / High Price $93.67 / $142.46 / $233.45	Professional		$93.67	$142.46	$233.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.94 / $55.98 / $86.00	Professional	26	$36.94	$55.98	$86.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.61 / $82.29 / $132.34	Professional	TC	$57.61	$82.29	$132.34