Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.00 / $20.03 / $69.37	Facility	26	$18.00	$20.03	$69.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.40 / $88.15 / $166.90	Professional		$65.40	$88.15	$166.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.33 / $19.07 / $35.49	Professional	26	$15.33	$19.07	$35.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.57 / $67.89 / $129.53	Professional	TC	$55.57	$67.89	$129.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.12 / $113.24 / $168.37	Professional		$83.12	$113.24	$168.37
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.73 / $22.78 / $34.04	Professional	26	$17.73	$22.78	$34.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.55 / $90.67 / $129.68	Professional	TC	$66.55	$90.67	$129.68
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $88.71 / $110.27 / $146.63	Professional		$88.71	$110.27	$146.63
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $22.83 / $22.83 / $28.99	Professional	26	$22.83	$22.83	$28.99
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $65.88 / $80.43 / $100.54	Professional	TC	$65.88	$80.43	$100.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.56 / $109.72 / $203.09	Professional		$75.56	$109.72	$203.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.96 / $25.85 / $43.98	Professional	26	$15.96	$25.85	$43.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.11 / $80.22 / $160.46	Professional	TC	$58.11	$80.22	$160.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.13 / $114.16 / $139.90	Professional		$95.13	$114.16	$139.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.13 / $22.40 / $26.87	Professional	26	$18.13	$22.40	$26.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $77.00 / $92.40 / $113.24	Professional	TC	$77.00	$92.40	$113.24
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $30.33 / $30.33 / $61.09	Facility	26	$30.33	$30.33	$61.09
Medcost Facility/Professional Professional Modifier Low / Median / High Price $26.00 / $88.00 / $170.00	Professional		$26.00	$88.00	$170.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $26.93 / $97.55 / $187.87	Professional		$26.93	$97.55	$187.87
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $20.56 / $28.14 / $44.56	Professional	26	$20.56	$28.14	$44.56
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $66.56 / $95.11 / $164.51	Professional	TC	$66.56	$95.11	$164.51
United Facility/Professional Professional Modifier Low / Median / High Price $72.51 / $110.62 / $174.97	Professional		$72.51	$110.62	$174.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.00 / $25.41 / $39.21	Professional	26	$16.00	$25.41	$39.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.57 / $85.81 / $137.19	Professional	TC	$56.57	$85.81	$137.19