Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.14 / $83.53 / $159.60	Facility	26	$49.14	$83.53	$159.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $157.71 / $162.22 / $316.93	Professional		$157.71	$162.22	$316.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.14 / $53.52 / $129.75	Professional	26	$49.14	$53.52	$129.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $106.17 / $110.68 / $221.44	Professional	TC	$106.17	$110.68	$221.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $157.84 / $201.79 / $282.98	Professional		$157.84	$201.79	$282.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.61 / $63.72 / $88.94	Professional	26	$49.61	$63.72	$88.94
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $108.23 / $138.36 / $194.03	Professional	TC	$108.23	$138.36	$194.03
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $181.56 / $593.63 / $897.47	Professional		$181.56	$593.63	$897.47
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $61.03 / $61.03 / $76.29	Professional	26	$61.03	$61.03	$76.29
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $116.65 / $132.80 / $193.28	Professional	TC	$116.65	$132.80	$193.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $148.10 / $255.36 / $410.26	Professional		$148.10	$255.36	$410.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.99 / $78.18 / $123.00	Professional	26	$44.99	$78.18	$123.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.07 / $169.61 / $297.26	Professional	TC	$101.07	$169.61	$297.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $172.91 / $237.41 / $247.30	Professional		$172.91	$237.41	$247.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.33 / $70.42 / $73.34	Professional	26	$54.33	$70.42	$73.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $118.58 / $166.99 / $169.62	Professional	TC	$118.58	$166.99	$169.62
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $64.94 / $86.15 / $101.00	Facility	26	$64.94	$86.15	$101.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $79.00 / $179.00 / $305.24	Professional		$79.00	$179.00	$305.24
Sentara Facility/Professional Professional Modifier Low / Median / High Price $69.90 / $206.46 / $397.70	Professional		$69.90	$206.46	$397.70
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $61.56 / $80.03 / $125.44	Professional	26	$61.56	$80.03	$125.44
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $132.54 / $175.53 / $266.17	Professional	TC	$132.54	$175.53	$266.17
United Facility/Professional Professional Modifier Low / Median / High Price $144.84 / $248.01 / $386.96	Professional		$144.84	$248.01	$386.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.97 / $82.37 / $121.57	Professional	26	$47.97	$82.37	$121.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.87 / $164.92 / $274.57	Professional	TC	$96.87	$164.92	$274.57