Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.11 / $54.63 / $154.06	Facility	26	$35.11	$54.63	$154.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.55 / $158.82 / $317.63	Professional		$134.55	$158.82	$317.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.11 / $48.14 / $88.02	Professional	26	$35.11	$48.14	$88.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.37 / $116.38 / $222.24	Professional	TC	$99.37	$116.38	$222.24
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.58 / $187.07 / $259.76	Professional		$144.58	$187.07	$259.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.42 / $44.02 / $63.91	Professional	26	$34.42	$44.02	$63.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.46 / $140.76 / $198.63	Professional	TC	$110.46	$140.76	$198.63
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $185.22 / $208.17 / $725.09	Professional		$185.22	$208.17	$725.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.81 / $45.10 / $85.24	Professional	26	$40.81	$45.10	$85.24
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $144.41 / $163.08 / $308.22	Professional	TC	$144.41	$163.08	$308.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.24 / $43.24 / $43.24	Facility	26	$43.24	$43.24	$43.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $155.31 / $236.27 / $370.44	Professional		$155.31	$236.27	$370.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.96 / $63.63 / $97.65	Professional	26	$36.96	$63.63	$97.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $118.35 / $175.14 / $283.61	Professional	TC	$118.35	$175.14	$283.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $150.50 / $187.77 / $229.39	Professional		$150.50	$187.77	$229.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.71 / $42.83 / $53.01	Professional	26	$33.71	$42.83	$53.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $114.68 / $146.13 / $179.22	Professional	TC	$114.68	$146.13	$179.22
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $63.99 / $100.00 / $125.73	Facility	26	$63.99	$100.00	$125.73
Medcost Facility/Professional Professional Modifier Low / Median / High Price $55.00 / $189.00 / $319.00	Professional		$55.00	$189.00	$319.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $73.69 / $211.28 / $368.78	Professional		$73.69	$211.28	$368.78
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $43.66 / $65.73 / $94.16	Professional	26	$43.66	$65.73	$94.16
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $130.02 / $176.34 / $258.27	Professional	TC	$130.02	$176.34	$258.27
United Facility/Professional Professional Modifier Low / Median / High Price $136.05 / $215.79 / $355.04	Professional		$136.05	$215.79	$355.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.70 / $54.26 / $88.31	Professional	26	$33.70	$54.26	$88.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.38 / $164.15 / $266.22	Professional	TC	$104.38	$164.15	$266.22