Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.00 / $91.79 / $162.69	Facility	26	$54.00	$91.79	$162.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.48 / $151.87 / $274.55	Professional		$115.48	$151.87	$274.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.67 / $79.06 / $203.58	Professional	26	$53.67	$79.06	$203.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.70 / $83.90 / $158.71	Professional	TC	$60.70	$83.90	$158.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $115.86 / $148.16 / $222.45	Professional		$115.86	$148.16	$222.45
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.31 / $70.51 / $106.21	Professional	26	$55.31	$70.51	$106.21
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.54 / $77.42 / $117.12	Professional	TC	$60.54	$77.42	$117.12
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $148.55 / $206.59 / $716.03	Professional		$148.55	$206.59	$716.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $65.77 / $68.12 / $68.12	Professional	26	$65.77	$68.12	$68.12
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $80.43 / $80.43 / $140.36	Professional	TC	$80.43	$80.43	$140.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.78 / $68.78 / $68.78	Facility	26	$68.78	$68.78	$68.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.16 / $198.58 / $341.96	Professional		$113.16	$198.58	$341.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.10 / $81.11 / $149.49	Professional	26	$52.10	$81.11	$149.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.62 / $110.62 / $179.01	Professional	TC	$58.62	$110.62	$179.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $124.67 / $168.34 / $176.83	Professional		$124.67	$168.34	$176.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.61 / $78.14 / $86.28	Professional	26	$59.61	$78.14	$86.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $65.06 / $90.84 / $93.17	Professional	TC	$65.06	$90.84	$93.17
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $88.71 / $120.00 / $179.92	Facility	26	$88.71	$120.00	$179.92
Medcost Facility/Professional Professional Modifier Low / Median / High Price $79.00 / $137.00 / $244.00	Professional		$79.00	$137.00	$244.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $72.89 / $169.49 / $2,954.00	Professional		$72.89	$169.49	$2,954.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $62.56 / $88.49 / $135.04	Professional	26	$62.56	$88.49	$135.04
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $73.25 / $108.43 / $155.81	Professional	TC	$73.25	$108.43	$155.81
United Facility/Professional Professional Modifier Low / Median / High Price $104.22 / $174.28 / $275.47	Professional		$104.22	$174.28	$275.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.96 / $75.20 / $121.88	Professional	26	$49.96	$75.20	$121.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.18 / $92.11 / $170.71	Professional	TC	$59.18	$92.11	$170.71