Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.07 / $92.17 / $166.87	Facility	26	$62.07	$92.17	$166.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.16 / $152.21 / $275.00	Professional		$133.16	$152.21	$275.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.54 / $75.12 / $114.13	Professional	26	$52.54	$75.12	$114.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.97 / $86.76 / $178.57	Professional	TC	$69.97	$86.76	$178.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $126.54 / $159.53 / $224.76	Professional		$126.54	$159.53	$224.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.32 / $78.31 / $110.50	Professional	26	$58.32	$78.31	$110.50
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.73 / $83.32 / $114.98	Professional	TC	$63.73	$83.32	$114.98
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $132.99 / $190.37 / $502.97	Professional		$132.99	$190.37	$502.97
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $59.27 / $75.27 / $112.02	Professional	26	$59.27	$75.27	$112.02
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $73.73 / $99.54 / $143.77	Professional	TC	$73.73	$99.54	$143.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.31 / $79.31 / $79.31	Facility	26	$79.31	$79.31	$79.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.13 / $197.87 / $408.45	Professional		$109.13	$197.87	$408.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.61 / $76.11 / $155.07	Professional	26	$50.61	$76.11	$155.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.04 / $106.64 / $303.89	Professional	TC	$54.04	$106.64	$303.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.52 / $144.62 / $178.37	Professional		$120.52	$144.62	$178.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $65.84 / $79.02 / $93.12	Professional	26	$65.84	$79.02	$93.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.67 / $67.64 / $82.89	Professional	TC	$54.67	$67.64	$82.89
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $81.42 / $105.01 / $197.12	Facility	26	$81.42	$105.01	$197.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $73.00 / $140.00 / $276.00	Professional		$73.00	$140.00	$276.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $73.30 / $185.76 / $354.42	Professional		$73.30	$185.76	$354.42
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $60.49 / $85.61 / $156.96	Professional	26	$60.49	$85.61	$156.96
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $78.06 / $121.28 / $243.03	Professional	TC	$78.06	$121.28	$243.03
United Facility/Professional Professional Modifier Low / Median / High Price $120.50 / $189.33 / $408.99	Professional		$120.50	$189.33	$408.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.97 / $76.06 / $136.41	Professional	26	$47.97	$76.06	$136.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.00 / $101.93 / $260.51	Professional	TC	$61.00	$101.93	$260.51