Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.07 / $38.76 / $110.08	Facility	26	$34.07	$38.76	$110.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.20 / $119.44 / $204.50	Professional		$82.20	$119.44	$204.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.86 / $36.93 / $74.55	Professional	26	$32.86	$36.93	$74.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.59 / $86.23 / $151.87	Professional	TC	$74.59	$86.23	$151.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.00 / $141.94 / $205.19	Professional		$112.00	$141.94	$205.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.47 / $42.71 / $62.20	Professional	26	$33.47	$42.71	$62.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.25 / $99.05 / $143.22	Professional	TC	$78.25	$99.05	$143.22
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $143.44 / $143.44 / $279.70	Professional		$143.44	$143.44	$279.70
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $42.55 / $42.55 / $54.04	Professional	26	$42.55	$42.55	$54.04
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $100.89 / $100.89 / $128.13	Professional	TC	$100.89	$100.89	$128.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.97 / $43.97 / $43.97	Facility	26	$43.97	$43.97	$43.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.72 / $168.70 / $292.91	Professional		$103.72	$168.70	$292.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.78 / $49.23 / $81.88	Professional	26	$30.78	$49.23	$81.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.14 / $118.07 / $204.78	Professional	TC	$72.14	$118.07	$204.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.51 / $144.62 / $177.23	Professional		$120.51	$144.62	$177.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.33 / $42.41 / $51.04	Professional	26	$34.33	$42.41	$51.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $86.18 / $103.42 / $126.74	Professional	TC	$86.18	$103.42	$126.74
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $44.69 / $71.67 / $119.98	Facility	26	$44.69	$71.67	$119.98
Medcost Facility/Professional Professional Modifier Low / Median / High Price $58.00 / $151.60 / $245.00	Professional		$58.00	$151.60	$245.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $52.10 / $153.74 / $283.85	Professional		$52.10	$153.74	$283.85
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $39.47 / $54.27 / $86.10	Professional	26	$39.47	$54.27	$86.10
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $93.64 / $122.67 / $197.78	Professional	TC	$93.64	$122.67	$197.78
United Facility/Professional Professional Modifier Low / Median / High Price $106.86 / $162.62 / $245.56	Professional		$106.86	$162.62	$245.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.04 / $49.37 / $80.02	Professional	26	$32.04	$49.37	$80.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.94 / $112.40 / $169.98	Professional	TC	$74.94	$112.40	$169.98