Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.53 / $97.06 / $240.23	Facility	26	$54.53	$97.06	$240.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.64 / $132.19 / $223.06	Professional		$107.64	$132.19	$223.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.09 / $62.23 / $102.51	Professional	26	$53.09	$62.23	$102.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.43 / $66.01 / $130.13	Professional	TC	$53.43	$66.01	$130.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.86 / $137.94 / $198.30	Professional		$107.86	$137.94	$198.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.51 / $69.02 / $96.04	Professional	26	$53.51	$69.02	$96.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $53.78 / $68.78 / $103.17	Professional	TC	$53.78	$68.78	$103.17
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $133.61 / $142.04 / $545.75	Professional		$133.61	$142.04	$545.75
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $64.18 / $65.67 / $124.12	Professional	26	$64.18	$65.67	$124.12
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $69.43 / $76.37 / $148.91	Professional	TC	$69.43	$76.37	$148.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.87 / $67.87 / $67.87	Facility	26	$67.87	$67.87	$67.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.34 / $184.25 / $298.63	Professional		$115.34	$184.25	$298.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.26 / $79.98 / $138.94	Professional	26	$58.26	$79.98	$138.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.08 / $101.63 / $173.67	Professional	TC	$57.08	$101.63	$173.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $110.03 / $135.91 / $165.40	Professional		$110.03	$135.91	$165.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.01 / $67.36 / $83.55	Professional	26	$53.01	$67.36	$83.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $55.31 / $70.43 / $84.91	Professional	TC	$55.31	$70.43	$84.91
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $67.36 / $103.00 / $157.03	Facility	26	$67.36	$103.00	$157.03
Medcost Facility/Professional Professional Modifier Low / Median / High Price $77.00 / $137.00 / $264.00	Professional		$77.00	$137.00	$264.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $69.75 / $150.03 / $281.70	Professional		$69.75	$150.03	$281.70
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $65.03 / $83.84 / $132.25	Professional	26	$65.03	$83.84	$132.25
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $64.36 / $89.88 / $159.71	Professional	TC	$64.36	$89.88	$159.71
United Facility/Professional Professional Modifier Low / Median / High Price $105.73 / $165.69 / $270.14	Professional		$105.73	$165.69	$270.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.20 / $73.70 / $123.26	Professional	26	$50.20	$73.70	$123.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $51.34 / $93.03 / $171.73	Professional	TC	$51.34	$93.03	$171.73