Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.51 / $95.62 / $288.39	Facility	26	$70.51	$95.62	$288.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.76 / $104.29 / $177.29	Professional		$90.76	$104.29	$177.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.85 / $69.17 / $110.25	Professional	26	$55.85	$69.17	$110.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.32 / $44.10 / $59.30	Professional	TC	$24.32	$44.10	$59.30
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $94.40 / $123.40 / $185.11	Professional		$94.40	$123.40	$185.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.39 / $69.56 / $104.35	Professional	26	$54.39	$69.56	$104.35
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.18 / $53.84 / $80.77	Professional	TC	$41.18	$53.84	$80.77
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $110.17 / $110.17 / $282.32	Professional		$110.17	$110.17	$282.32
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $61.57 / $61.57 / $116.37	Professional	26	$61.57	$61.57	$116.37
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $48.61 / $48.61 / $91.87	Professional	TC	$48.61	$48.61	$91.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.84 / $129.97 / $247.44	Professional		$96.84	$129.97	$247.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.51 / $82.60 / $155.75	Professional	26	$58.51	$82.60	$155.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.38 / $43.91 / $92.28	Professional	TC	$31.38	$43.91	$92.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.84 / $114.80 / $174.29	Professional		$91.84	$114.80	$174.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.51 / $63.14 / $107.49	Professional	26	$50.51	$63.14	$107.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.33 / $51.66 / $69.73	Professional	TC	$41.33	$51.66	$69.73
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $71.38 / $82.02 / $161.31	Facility	26	$71.38	$82.02	$161.31
Medcost Facility/Professional Professional Modifier Low / Median / High Price $37.00 / $90.38 / $164.00	Professional		$37.00	$90.38	$164.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $36.08 / $99.67 / $189.52	Professional		$36.08	$99.67	$189.52
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $61.84 / $79.11 / $128.05	Professional	26	$61.84	$79.11	$128.05
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $27.56 / $44.06 / $83.85	Professional	TC	$27.56	$44.06	$83.85
United Facility/Professional Professional Modifier Low / Median / High Price $80.56 / $120.85 / $189.16	Professional		$80.56	$120.85	$189.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.70 / $76.03 / $118.93	Professional	26	$51.70	$76.03	$118.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.06 / $41.33 / $69.02	Professional	TC	$27.06	$41.33	$69.02