Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.61 / $106.94 / $325.61	Facility	26	$79.61	$106.94	$325.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $184.90 / $212.65 / $383.53	Professional		$184.90	$212.65	$383.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.91 / $79.61 / $137.37	Professional	26	$62.91	$79.61	$137.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $115.22 / $142.30 / $244.66	Professional	TC	$115.22	$142.30	$244.66
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $168.73 / $218.51 / $327.79	Professional		$168.73	$218.51	$327.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.08 / $79.39 / $121.53	Professional	26	$62.08	$79.39	$121.53
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.42 / $139.12 / $208.70	Professional	TC	$107.42	$139.12	$208.70
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $202.39 / $202.39 / $481.10	Professional		$202.39	$202.39	$481.10
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $66.18 / $66.18 / $125.08	Professional	26	$66.18	$66.18	$125.08
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $136.21 / $136.21 / $257.44	Professional	TC	$136.21	$136.21	$257.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $172.23 / $263.13 / $471.59	Professional		$172.23	$263.13	$471.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.89 / $96.85 / $175.56	Professional	26	$68.89	$96.85	$175.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $92.83 / $170.31 / $293.32	Professional	TC	$92.83	$170.31	$293.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.81 / $214.70 / $264.16	Professional		$173.81	$214.70	$264.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.76 / $77.20 / $95.98	Professional	26	$60.76	$77.20	$95.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $109.66 / $139.66 / $174.28	Professional	TC	$109.66	$139.66	$174.28
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $81.30 / $147.00 / $206.00	Facility	26	$81.30	$147.00	$206.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $93.43 / $207.04 / $346.80	Professional		$93.43	$207.04	$346.80
Sentara Facility/Professional Professional Modifier Low / Median / High Price $88.16 / $229.34 / $451.47	Professional		$88.16	$229.34	$451.47
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $75.90 / $100.19 / $153.47	Professional	26	$75.90	$100.19	$153.47
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $123.55 / $179.45 / $277.39	Professional	TC	$123.55	$179.45	$277.39
United Facility/Professional Professional Modifier Low / Median / High Price $147.72 / $219.94 / $380.82	Professional		$147.72	$219.94	$380.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.05 / $88.06 / $141.28	Professional	26	$58.05	$88.06	$141.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.27 / $137.30 / $246.20	Professional	TC	$87.27	$137.30	$246.20