Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.18 / $75.08 / $135.68	Facility	26	$42.18	$75.08	$135.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.85 / $144.69 / $264.56	Professional		$119.85	$144.69	$264.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.17 / $45.55 / $91.86	Professional	26	$42.17	$45.55	$91.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.19 / $87.95 / $165.04	Professional	TC	$77.19	$87.95	$165.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.08 / $156.59 / $220.02	Professional		$125.08	$156.59	$220.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.02 / $53.86 / $75.68	Professional	26	$43.02	$53.86	$75.68
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.02 / $102.97 / $143.91	Professional	TC	$81.02	$102.97	$143.91
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $155.76 / $155.76 / $448.10	Professional		$155.76	$155.76	$448.10
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.81 / $52.81 / $99.81	Professional	26	$52.81	$52.81	$99.81
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $102.95 / $102.95 / $194.58	Professional	TC	$102.95	$102.95	$194.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.96 / $53.96 / $53.96	Facility	26	$53.96	$53.96	$53.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.82 / $173.57 / $318.58	Professional		$108.82	$173.57	$318.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.01 / $61.34 / $111.86	Professional	26	$38.01	$61.34	$111.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.51 / $111.95 / $208.41	Professional	TC	$70.51	$111.95	$208.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.04 / $158.16 / $195.10	Professional		$128.04	$158.16	$195.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.51 / $54.01 / $66.84	Professional	26	$42.51	$54.01	$66.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.93 / $105.65 / $131.82	Professional	TC	$82.93	$105.65	$131.82
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $69.89 / $97.00 / $137.91	Facility	26	$69.89	$97.00	$137.91
Medcost Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $135.00 / $232.00	Professional		$65.00	$135.00	$232.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $62.67 / $166.80 / $328.55	Professional		$62.67	$166.80	$328.55
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $50.89 / $66.81 / $105.80	Professional	26	$50.89	$66.81	$105.80
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $91.28 / $130.11 / $203.80	Professional	TC	$91.28	$130.11	$203.80
United Facility/Professional Professional Modifier Low / Median / High Price $106.05 / $156.68 / $241.44	Professional		$106.05	$156.68	$241.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.94 / $55.61 / $80.72	Professional	26	$36.94	$55.61	$80.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.63 / $93.91 / $164.79	Professional	TC	$69.63	$93.91	$164.79