Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.62 / $92.32 / $264.30	Facility	26	$64.62	$92.32	$264.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.51 / $96.79 / $163.13	Professional		$81.51	$96.79	$163.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.42 / $63.15 / $101.66	Professional	26	$50.42	$63.15	$101.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.10 / $40.61 / $55.38	Professional	TC	$25.10	$40.61	$55.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.48 / $114.36 / $171.56	Professional		$87.48	$114.36	$171.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.09 / $64.06 / $96.09	Professional	26	$50.09	$64.06	$96.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.47 / $50.30 / $75.45	Professional	TC	$38.47	$50.30	$75.45
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $102.16 / $102.16 / $266.80	Professional		$102.16	$102.16	$266.80
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $56.63 / $56.63 / $107.03	Professional	26	$56.63	$56.63	$107.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $45.53 / $45.53 / $86.05	Professional	TC	$45.53	$45.53	$86.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.43 / $116.55 / $228.90	Professional		$89.43	$116.55	$228.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.89 / $74.75 / $143.60	Professional	26	$53.89	$74.75	$143.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.42 / $40.70 / $86.07	Professional	TC	$28.42	$40.70	$86.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.10 / $106.37 / $161.33	Professional		$85.10	$106.37	$161.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.54 / $58.18 / $99.17	Professional	26	$46.54	$58.18	$99.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.54 / $48.19 / $65.06	Professional	TC	$38.54	$48.19	$65.06
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $64.58 / $68.95 / $152.51	Facility	26	$64.58	$68.95	$152.51
Medcost Facility/Professional Professional Modifier Low / Median / High Price $32.00 / $83.28 / $144.00	Professional		$32.00	$83.28	$144.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $32.52 / $93.31 / $173.18	Professional		$32.52	$93.31	$173.18
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $56.68 / $68.73 / $117.86	Professional	26	$56.68	$68.73	$117.86
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $24.24 / $41.17 / $78.04	Professional	TC	$24.24	$41.17	$78.04
United Facility/Professional Professional Modifier Low / Median / High Price $72.43 / $108.75 / $169.19	Professional		$72.43	$108.75	$169.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.00 / $69.64 / $107.95	Professional	26	$47.00	$69.64	$107.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.85 / $37.29 / $62.01	Professional	TC	$24.85	$37.29	$62.01