Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.01 / $88.60 / $166.60	Facility	26	$75.01	$88.60	$166.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.52 / $158.63 / $225.64	Professional		$127.52	$158.63	$225.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.34 / $80.29 / $105.89	Professional	26	$65.34	$80.29	$105.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.03 / $80.56 / $111.23	Professional	TC	$55.03	$80.56	$111.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $129.61 / $178.85 / $281.81	Professional		$129.61	$178.85	$281.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.98 / $91.47 / $140.43	Professional	26	$68.98	$91.47	$140.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.84 / $89.80 / $139.06	Professional	TC	$58.84	$89.80	$139.06
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $166.58 / $172.58 / $336.53	Professional		$166.58	$172.58	$336.53
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $86.68 / $86.68 / $169.03	Professional	26	$86.68	$86.68	$169.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $79.90 / $85.90 / $167.50	Professional	TC	$79.90	$85.90	$167.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $122.30 / $192.95 / $345.19	Professional		$122.30	$192.95	$345.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.58 / $109.39 / $187.17	Professional	26	$76.58	$109.39	$187.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.57 / $103.54 / $198.42	Professional	TC	$38.57	$103.54	$198.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $145.65 / $176.92 / $222.76	Professional		$145.65	$176.92	$222.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $71.92 / $88.84 / $109.99	Professional	26	$71.92	$88.84	$109.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.62 / $86.75 / $112.78	Professional	TC	$73.62	$86.75	$112.78
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $80.45 / $105.00 / $210.63	Facility	26	$80.45	$105.00	$210.63
Medcost Facility/Professional Professional Modifier Low / Median / High Price $92.00 / $133.00 / $245.00	Professional		$92.00	$133.00	$245.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $75.72 / $164.79 / $371.46	Professional		$75.72	$164.79	$371.46
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $81.20 / $113.11 / $182.10	Professional	26	$81.20	$113.11	$182.10
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $65.65 / $115.18 / $201.54	Professional	TC	$65.65	$115.18	$201.54
United Facility/Professional Professional Modifier Low / Median / High Price $108.97 / $184.55 / $343.13	Professional		$108.97	$184.55	$343.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.31 / $108.79 / $167.18	Professional	26	$66.31	$108.79	$167.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.09 / $88.50 / $174.72	Professional	TC	$31.09	$88.50	$174.72