Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.49 / $49.68 / $155.18	Facility	26	$35.49	$49.68	$155.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $179.25 / $212.83 / $364.25	Professional		$179.25	$212.83	$364.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.53 / $42.75 / $73.17	Professional	26	$31.53	$42.75	$73.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.59 / $170.08 / $282.98	Professional	TC	$142.59	$170.08	$282.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $172.97 / $223.38 / $309.17	Professional		$172.97	$223.38	$309.17
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.67 / $43.31 / $60.74	Professional	26	$33.67	$43.31	$60.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.97 / $179.99 / $248.42	Professional	TC	$138.97	$179.99	$248.42
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $198.74 / $202.32 / $816.54	Professional		$198.74	$202.32	$816.54
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $31.59 / $35.10 / $66.34	Professional	26	$31.59	$35.10	$66.34
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $167.21 / $167.21 / $316.02	Professional	TC	$167.21	$167.21	$316.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.27 / $43.27 / $43.27	Facility	26	$43.27	$43.27	$43.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $183.46 / $269.23 / $446.02	Professional		$183.46	$269.23	$446.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.29 / $43.34 / $89.51	Professional	26	$32.29	$43.34	$89.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.58 / $224.68 / $362.47	Professional	TC	$147.58	$224.68	$362.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $178.68 / $223.79 / $277.81	Professional		$178.68	$223.79	$277.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.69 / $42.80 / $52.79	Professional	26	$33.69	$42.80	$52.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $143.01 / $182.15 / $227.11	Professional	TC	$143.01	$182.15	$227.11
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $31.98 / $83.90 / $123.00	Facility	26	$31.98	$83.90	$123.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $249.00 / $390.00	Professional		$49.00	$249.00	$390.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $43.59 / $241.53 / $468.68	Professional		$43.59	$241.53	$468.68
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $28.98 / $48.35 / $84.43	Professional	26	$28.98	$48.35	$84.43
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $177.28 / $233.81 / $363.16	Professional	TC	$177.28	$233.81	$363.16
United Facility/Professional Professional Modifier Low / Median / High Price $169.44 / $264.97 / $428.01	Professional		$169.44	$264.97	$428.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.31 / $41.59 / $79.94	Professional	26	$26.31	$41.59	$79.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $129.59 / $210.89 / $349.18	Professional	TC	$129.59	$210.89	$349.18