Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.81 / $47.79 / $338.51	Facility	26	$41.81	$47.79	$338.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $135.13 / $151.74 / $257.95	Professional		$135.13	$151.74	$257.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.29 / $45.52 / $85.22	Professional	26	$40.29	$45.52	$85.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.39 / $105.60 / $186.88	Professional	TC	$95.39	$105.60	$186.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.08 / $179.70 / $259.76	Professional		$141.08	$179.70	$259.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.12 / $52.46 / $76.40	Professional	26	$41.12	$52.46	$76.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $99.66 / $126.84 / $183.68	Professional	TC	$99.66	$126.84	$183.68
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $181.25 / $181.25 / $353.44	Professional		$181.25	$181.25	$353.44
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.61 / $52.61 / $66.81	Professional	26	$52.61	$52.61	$66.81
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $128.63 / $128.63 / $163.37	Professional	TC	$128.63	$128.63	$163.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.54 / $213.64 / $370.90	Professional		$131.54	$213.64	$370.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.94 / $61.26 / $101.23	Professional	26	$37.94	$61.26	$101.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.98 / $151.05 / $262.61	Professional	TC	$91.98	$151.05	$262.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.91 / $182.30 / $223.41	Professional		$151.91	$182.30	$223.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.14 / $52.06 / $62.71	Professional	26	$42.14	$52.06	$62.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $109.78 / $131.72 / $161.44	Professional	TC	$109.78	$131.72	$161.44
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $54.98 / $89.10 / $147.12	Facility	26	$54.98	$89.10	$147.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $72.00 / $193.61 / $308.00	Professional		$72.00	$193.61	$308.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $64.77 / $195.03 / $359.34	Professional		$64.77	$195.03	$359.34
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $49.07 / $66.92 / $106.48	Professional	26	$49.07	$66.92	$106.48
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $119.80 / $156.94 / $252.89	Professional	TC	$119.80	$156.94	$252.89
United Facility/Professional Professional Modifier Low / Median / High Price $131.88 / $213.05 / $332.69	Professional		$131.88	$213.05	$332.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.35 / $61.14 / $92.25	Professional	26	$38.35	$61.14	$92.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.54 / $155.24 / $222.45	Professional	TC	$95.54	$155.24	$222.45