Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $104.71 / $281.84	Facility	26	$61.66	$104.71	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $173.78 / $407.38	Professional		$131.83	$173.78	$407.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $91.20 / $199.53	Professional	26	$56.23	$91.20	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $93.33 / $218.78	Professional	TC	$67.61	$93.33	$218.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $177.83 / $295.12	Professional		$128.82	$177.83	$295.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $87.10 / $144.54	Professional	26	$60.26	$87.10	$144.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $93.33 / $147.91	Professional	TC	$66.07	$93.33	$147.91
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $162.18 / $549.54	Professional		$87.10	$162.18	$549.54
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $100.00 / $144.54	Professional	26	$79.43	$100.00	$144.54
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $123.03 / $288.40	Professional	TC	$72.44	$123.03	$288.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	26	$16.98	$79.43	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $194.98 / $407.38	Professional		$107.15	$194.98	$407.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $141.25	Professional	26	$50.12	$70.79	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $104.71 / $302.00	Professional	TC	$53.70	$104.71	$302.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $144.54 / $199.53	Professional		$117.49	$144.54	$199.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $75.86 / $97.72	Professional	26	$61.66	$75.86	$97.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $67.61 / $107.15	Professional	TC	$54.95	$67.61	$107.15
Medcost Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $245.47 / $316.23	Professional		$199.53	$245.47	$316.23
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $100.00 / $151.36	Professional	26	$81.28	$100.00	$151.36
Medcost Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $144.54 / $229.09	Professional		$144.54	$144.54	$229.09
Sentara Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $165.96 / $389.05	Professional		$66.07	$165.96	$389.05
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $79.43 / $141.25	Professional	26	$58.88	$79.43	$141.25
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $112.20 / $245.47	Professional	TC	$72.44	$112.20	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $186.21 / $389.05	Professional		$112.20	$186.21	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $72.44 / $128.82	Professional	26	$43.65	$72.44	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $102.33 / $302.00	Professional	TC	$57.54	$102.33	$302.00