Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $50.12 / $204.17	Facility	26	$39.81	$50.12	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $158.49 / $316.23	Professional		$125.89	$158.49	$316.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $51.29 / $120.23	Professional	26	$39.81	$51.29	$120.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $107.15 / $194.98	Professional	TC	$85.11	$107.15	$194.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $194.98 / $269.15	Professional		$134.90	$194.98	$269.15
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $60.26 / $87.10	Professional	26	$42.66	$60.26	$87.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $131.83 / $186.21	Professional	TC	$93.33	$131.83	$186.21
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $151.36 / $812.83	Professional		$114.82	$151.36	$812.83
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $45.71 / $52.48	Professional	26	$40.74	$45.71	$52.48
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $107.15 / $120.23	Professional	TC	$95.50	$107.15	$120.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $70.79	Facility	26	$10.47	$48.98	$70.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $208.93 / $338.84	Professional		$138.04	$208.93	$338.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $61.66 / $107.15	Professional	26	$43.65	$61.66	$107.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $144.54 / $239.88	Professional	TC	$91.20	$144.54	$239.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $158.49 / $199.53	Professional		$125.89	$158.49	$199.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $46.77 / $60.26	Professional	26	$37.15	$46.77	$60.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $112.20 / $138.04	Professional	TC	$89.13	$112.20	$138.04
Medcost Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $275.42 / $281.84	Professional		$218.78	$275.42	$281.84
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $70.79 / $81.28	Professional	26	$57.54	$70.79	$81.28
Medcost Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $194.98 / $194.98	Professional		$194.98	$194.98	$194.98
Sentara Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $162.18 / $331.13	Professional		$57.54	$162.18	$331.13
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $61.66 / $95.50	Professional	26	$45.71	$61.66	$95.50
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $138.04 / $218.78	Professional	TC	$93.33	$138.04	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $186.21 / $309.03	Professional		$125.89	$186.21	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $53.70 / $89.13	Professional	26	$37.15	$53.70	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $131.83 / $218.78	Professional	TC	$83.18	$131.83	$218.78