Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.11 / $50.45 / $206.34	Facility	26	$40.11	$50.45	$206.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $129.72 / $155.57 / $254.13	Professional		$129.72	$155.57	$254.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.11 / $50.45 / $82.01	Professional	26	$40.11	$50.45	$82.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.01 / $105.12 / $173.76	Professional	TC	$86.01	$105.12	$173.76
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.69 / $160.74 / $241.12	Professional		$125.69	$160.74	$241.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.61 / $49.91 / $74.88	Professional	26	$39.61	$49.91	$74.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $86.66 / $110.83 / $166.26	Professional	TC	$86.66	$110.83	$166.26
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $142.30 / $158.11 / $667.60	Professional		$142.30	$158.11	$667.60
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $46.23 / $48.68 / $92.01	Professional	26	$46.23	$48.68	$92.01
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $97.90 / $97.90 / $185.03	Professional	TC	$97.90	$97.90	$185.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.06 / $49.06 / $49.06	Facility	26	$49.06	$49.06	$49.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.11 / $201.91 / $350.93	Professional		$137.11	$201.91	$350.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.68 / $61.65 / $112.97	Professional	26	$43.68	$61.65	$112.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $92.22 / $138.32 / $238.40	Professional	TC	$92.22	$138.32	$238.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $129.07 / $159.71 / $196.04	Professional		$129.07	$159.71	$196.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.51 / $48.93 / $60.75	Professional	26	$38.51	$48.93	$60.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $88.02 / $112.13 / $138.72	Professional	TC	$88.02	$112.13	$138.72
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $51.05 / $116.87 / $150.00	Facility	26	$51.05	$116.87	$150.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $59.38 / $137.00 / $258.00	Professional		$59.38	$137.00	$258.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $61.43 / $173.53 / $319.23	Professional		$61.43	$173.53	$319.23
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $47.99 / $63.49 / $98.21	Professional	26	$47.99	$63.49	$98.21
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $94.16 / $142.41 / $220.48	Professional	TC	$94.16	$142.41	$220.48
United Facility/Professional Professional Modifier Low / Median / High Price $115.20 / $184.18 / $303.08	Professional		$115.20	$184.18	$303.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.78 / $56.00 / $90.25	Professional	26	$36.78	$56.00	$90.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.84 / $130.37 / $212.45	Professional	TC	$82.84	$130.37	$212.45