Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $29.51 / $123.03	Facility	26	$18.20	$29.51	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $104.71 / $223.87	Professional		$70.79	$104.71	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $25.70 / $54.95	Professional	26	$16.98	$25.70	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $75.86 / $147.91	Professional	TC	$52.48	$75.86	$147.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $128.82 / $194.98	Professional		$91.20	$128.82	$194.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $25.70 / $38.90	Professional	26	$18.62	$25.70	$38.90
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $102.33 / $154.88	Professional	TC	$72.44	$102.33	$154.88
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $112.20 / $158.49	Professional		$19.05	$112.20	$158.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $21.38 / $32.36	Professional	26	$21.38	$21.38	$32.36
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $91.20 / $138.04	Professional	TC	$81.28	$91.20	$138.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.90 / $22.91 / $32.36	Facility	26	$4.90	$22.91	$32.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $104.71 / $199.53	Professional		$72.44	$104.71	$199.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $25.12 / $42.66	Professional	26	$15.49	$25.12	$42.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $77.62 / $162.18	Professional	TC	$56.23	$77.62	$162.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $117.49 / $144.54	Professional		$97.72	$117.49	$144.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $22.39 / $26.92	Professional	26	$18.20	$22.39	$26.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $95.50 / $117.49	Professional	TC	$77.62	$95.50	$117.49
Medcost Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $213.80	Professional		$213.80	$213.80	$213.80
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $42.66 / $42.66	Professional	26	$42.66	$42.66	$42.66
Medcost Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $70.79 / $162.18	Professional		$70.79	$70.79	$162.18
Sentara Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $93.33 / $213.80	Professional		$25.12	$93.33	$213.80
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $26.30 / $44.67	Professional	26	$20.42	$26.30	$44.67
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $89.13 / $165.96	Professional	TC	$58.88	$89.13	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $100.00 / $177.83	Professional		$64.57	$100.00	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $23.44 / $41.69	Professional	26	$15.49	$23.44	$41.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $77.62 / $138.04	Professional	TC	$48.98	$77.62	$138.04