Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.64 / $64.15 / $232.87	Facility	26	$54.64	$64.15	$232.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.91 / $163.85 / $280.63	Professional		$152.91	$163.85	$280.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.46 / $59.07 / $90.52	Professional	26	$53.46	$59.07	$90.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.84 / $109.21 / $190.10	Professional	TC	$95.84	$109.21	$190.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $184.37 / $379.21 / $532.65	Professional		$184.37	$379.21	$532.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.47 / $67.78 / $94.37	Professional	26	$53.47	$67.78	$94.37
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $119.18 / $312.01 / $438.26	Professional	TC	$119.18	$312.01	$438.26
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $350.69 / $389.66 / $949.56	Professional		$350.69	$389.66	$949.56
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $61.74 / $67.73 / $128.03	Professional	26	$61.74	$67.73	$128.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $289.73 / $321.92 / $608.42	Professional	TC	$289.73	$321.92	$608.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.70 / $66.70 / $66.70	Facility	26	$66.70	$66.70	$66.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $283.44 / $399.18 / $733.71	Professional		$283.44	$399.18	$733.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.58 / $76.72 / $135.49	Professional	26	$56.58	$76.72	$135.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $217.97 / $323.02 / $610.17	Professional	TC	$217.97	$323.02	$610.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $279.14 / $349.70 / $463.64	Professional		$279.14	$349.70	$463.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.39 / $66.43 / $81.93	Professional	26	$52.39	$66.43	$81.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.78 / $284.98 / $385.58	Professional	TC	$223.78	$284.98	$385.58
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $59.24 / $72.14 / $157.60	Facility	26	$59.24	$72.14	$157.60
Medcost Facility/Professional Professional Modifier Low / Median / High Price $79.01 / $330.00 / $479.00	Professional		$79.01	$330.00	$479.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $73.81 / $211.20 / $350.53	Professional		$73.81	$211.20	$350.53
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $62.94 / $79.91 / $128.44	Professional	26	$62.94	$79.91	$128.44
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $120.78 / $161.09 / $251.23	Professional	TC	$120.78	$161.09	$251.23
United Facility/Professional Professional Modifier Low / Median / High Price $235.99 / $349.75 / $615.70	Professional		$235.99	$349.75	$615.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.31 / $70.55 / $120.04	Professional	26	$46.31	$70.55	$120.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $184.80 / $279.20 / $494.21	Professional	TC	$184.80	$279.20	$494.21