Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.76 / $56.62 / $100.12	Facility	26	$33.76	$56.62	$100.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $191.65 / $262.62 / $490.16	Professional		$191.65	$262.62	$490.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.35 / $35.42 / $68.17	Professional	26	$30.35	$35.42	$68.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.46 / $228.41 / $424.89	Professional	TC	$159.46	$228.41	$424.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $242.91 / $312.01 / $435.50	Professional		$242.91	$312.01	$435.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.42 / $43.87 / $66.08	Professional	26	$34.42	$43.87	$66.08
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $211.40 / $268.77 / $375.14	Professional	TC	$211.40	$268.77	$375.14
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $215.33 / $271.57 / $652.29	Professional		$215.33	$271.57	$652.29
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $37.15 / $37.57	Professional	26	$37.15	$37.15	$37.57
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $149.93 / $234.42 / $234.42	Professional	TC	$149.93	$234.42	$234.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.72 / $42.72 / $42.72	Facility	26	$42.72	$42.72	$42.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.40 / $276.50 / $690.00	Professional		$185.40	$276.50	$690.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.93 / $48.24 / $94.34	Professional	26	$31.93	$48.24	$94.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $157.66 / $231.14 / $595.66	Professional	TC	$157.66	$231.14	$595.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $260.87 / $365.21 / $378.79	Professional		$260.87	$365.21	$378.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.00 / $48.59 / $50.61	Professional	26	$37.00	$48.59	$50.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $227.06 / $317.02 / $325.29	Professional	TC	$227.06	$317.02	$325.29
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $50.42 / $58.00 / $110.60	Facility	26	$50.42	$58.00	$110.60
Medcost Facility/Professional Professional Modifier Low / Median / High Price $48.00 / $278.00 / $508.00	Professional		$48.00	$278.00	$508.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $48.09 / $285.05 / $1,221.00	Professional		$48.09	$285.05	$1,221.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $37.93 / $52.44 / $83.03	Professional	26	$37.93	$52.44	$83.03
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $177.18 / $299.52 / $543.59	Professional	TC	$177.18	$299.52	$543.59
United Facility/Professional Professional Modifier Low / Median / High Price $166.53 / $295.12 / $495.75	Professional		$166.53	$295.12	$495.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.25 / $46.30 / $76.70	Professional	26	$29.25	$46.30	$76.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.79 / $251.02 / $429.63	Professional	TC	$138.79	$251.02	$429.63