Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.11 / $98.75 / $162.30	Facility	26	$73.11	$98.75	$162.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.10 / $151.37 / $249.53	Professional		$124.10	$151.37	$249.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.87 / $82.73 / $145.77	Professional	26	$68.87	$82.73	$145.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.63 / $64.59 / $103.58	Professional	TC	$52.63	$64.59	$103.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.80 / $150.41 / $237.00	Professional		$108.80	$150.41	$237.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.85 / $86.81 / $136.78	Professional	26	$62.85	$86.81	$136.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.39 / $63.60 / $100.21	Professional	TC	$47.39	$63.60	$100.21
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $127.82 / $131.88 / $257.17	Professional		$127.82	$131.88	$257.17
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $68.22 / $72.28 / $140.94	Professional	26	$68.22	$72.28	$140.94
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $59.60 / $59.60 / $116.22	Professional	TC	$59.60	$59.60	$116.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.22 / $184.70 / $321.58	Professional		$118.22	$184.70	$321.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.93 / $107.09 / $182.54	Professional	26	$74.93	$107.09	$182.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.75 / $83.83 / $143.85	Professional	TC	$53.75	$83.83	$143.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $124.50 / $152.15 / $190.41	Professional		$124.50	$152.15	$190.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.43 / $87.00 / $107.72	Professional	26	$70.43	$87.00	$107.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.01 / $63.61 / $82.69	Professional	TC	$54.01	$63.61	$82.69
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $105.24 / $171.04 / $212.82	Facility	26	$105.24	$171.04	$212.82
Medcost Facility/Professional Professional Modifier Low / Median / High Price $84.47 / $118.00 / $234.47	Professional		$84.47	$118.00	$234.47
Sentara Facility/Professional Professional Modifier Low / Median / High Price $73.80 / $157.60 / $300.66	Professional		$73.80	$157.60	$300.66
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $80.26 / $109.29 / $174.64	Professional	26	$80.26	$109.29	$174.64
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $60.42 / $86.40 / $141.88	Professional	TC	$60.42	$86.40	$141.88
United Facility/Professional Professional Modifier Low / Median / High Price $118.37 / $199.29 / $294.32	Professional		$118.37	$199.29	$294.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.05 / $109.09 / $163.22	Professional	26	$66.05	$109.09	$163.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.05 / $88.81 / $138.04	Professional	TC	$52.05	$88.81	$138.04