Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.45 / $37.45 / $105.15	Facility	26	$37.45	$37.45	$105.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.50 / $136.63 / $230.28	Professional		$78.50	$136.63	$230.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.08 / $45.03 / $82.78	Professional	26	$35.08	$45.03	$82.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.05 / $90.37 / $154.94	Professional	TC	$41.05	$90.37	$154.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.45 / $181.82 / $265.76	Professional		$112.45	$181.82	$265.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.27 / $47.27 / $73.09	Professional	26	$37.27	$47.27	$73.09
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $180.72 / $273.33 / $423.27	Professional	50	$180.72	$273.33	$423.27
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $73.44 / $135.52 / $198.09	Professional	TC	$73.44	$135.52	$198.09
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $98.55 / $137.84 / $387.77	Professional		$98.55	$137.84	$387.77
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $31.10 / $37.97 / $47.47	Professional	26	$31.10	$37.97	$47.47
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $67.45 / $87.59 / $115.22	Professional	TC	$67.45	$87.59	$115.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.14 / $47.14 / $47.14	Facility	26	$47.14	$47.14	$47.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.99 / $162.05 / $252.99	Professional		$110.99	$162.05	$252.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.65 / $56.17 / $94.91	Professional	26	$38.65	$56.17	$94.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.79 / $109.93 / $163.66	Professional	TC	$62.79	$109.93	$163.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.90 / $182.27 / $214.44	Professional		$151.90	$182.27	$214.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.17 / $47.16 / $56.40	Professional	26	$38.17	$47.16	$56.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $113.72 / $136.47 / $160.55	Professional	TC	$113.72	$136.47	$160.55
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $43.00 / $45.01 / $114.08	Facility	26	$43.00	$45.01	$114.08
Medcost Facility/Professional Professional Modifier Low / Median / High Price $54.00 / $106.00 / $206.00	Professional		$54.00	$106.00	$206.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $57.21 / $148.37 / $243.92	Professional		$57.21	$148.37	$243.92
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $42.46 / $60.82 / $92.34	Professional	26	$42.46	$60.82	$92.34
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $81.47 / $113.62 / $166.05	Professional	TC	$81.47	$113.62	$166.05
United Facility/Professional Professional Modifier Low / Median / High Price $91.26 / $139.46 / $221.41	Professional		$91.26	$139.46	$221.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.08 / $52.61 / $83.50	Professional	26	$35.08	$52.61	$83.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.01 / $79.90 / $124.99	Professional	TC	$55.01	$79.90	$124.99