Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.14 / $42.35 / $153.72	Facility	26	$35.14	$42.35	$153.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.95 / $217.28 / $371.85	Professional		$182.95	$217.28	$371.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.91 / $41.94 / $72.47	Professional	26	$23.91	$41.94	$72.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $146.29 / $174.93 / $299.61	Professional	TC	$146.29	$174.93	$299.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $178.58 / $229.70 / $322.19	Professional		$178.58	$229.70	$322.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.90 / $43.31 / $60.74	Professional	26	$32.90	$43.31	$60.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $146.27 / $186.39 / $261.44	Professional	TC	$146.27	$186.39	$261.44
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $202.14 / $232.01 / $777.28	Professional		$202.14	$232.01	$777.28
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $31.31 / $34.78 / $65.73	Professional	26	$31.31	$34.78	$65.73
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $167.36 / $167.36 / $316.31	Professional	TC	$167.36	$167.36	$316.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.28 / $43.28 / $43.28	Facility	26	$43.28	$43.28	$43.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.21 / $279.67 / $460.84	Professional		$190.21	$279.67	$460.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.37 / $40.49 / $89.93	Professional	26	$26.37	$40.49	$89.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $155.63 / $236.65 / $376.95	Professional	TC	$155.63	$236.65	$376.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $187.44 / $235.11 / $284.72	Professional		$187.44	$235.11	$284.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.69 / $42.72 / $52.69	Professional	26	$33.69	$42.72	$52.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $151.85 / $193.48 / $234.52	Professional	TC	$151.85	$193.48	$234.52
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $24.38 / $39.00 / $103.93	Facility	26	$24.38	$39.00	$103.93
Medcost Facility/Professional Professional Modifier Low / Median / High Price $38.00 / $257.00 / $396.00	Professional		$38.00	$257.00	$396.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $36.71 / $238.80 / $439.72	Professional		$36.71	$238.80	$439.72
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $26.65 / $44.11 / $85.73	Professional	26	$26.65	$44.11	$85.73
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $184.40 / $239.91 / $372.65	Professional	TC	$184.40	$239.91	$372.65
United Facility/Professional Professional Modifier Low / Median / High Price $168.29 / $264.69 / $412.68	Professional		$168.29	$264.69	$412.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.42 / $38.93 / $79.25	Professional	26	$21.42	$38.93	$79.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.19 / $222.16 / $365.41	Professional	TC	$138.19	$222.16	$365.41