Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $79.43 / $190.55	Facility	26	$41.69	$79.43	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $199.53 / $537.03	Professional		$131.83	$199.53	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $63.10 / $169.82	Professional	26	$43.65	$63.10	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $120.23 / $309.03	Professional	TC	$83.18	$120.23	$309.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $181.97 / $295.12	Professional		$128.82	$181.97	$295.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $60.26 / $97.72	Professional	26	$44.67	$60.26	$97.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $117.49 / $199.53	Professional	TC	$83.18	$117.49	$199.53
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $186.21 / $1,000.00	Professional		$54.95	$186.21	$1,000.00
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $61.66 / $93.33	Professional	26	$50.12	$61.66	$93.33
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $123.03 / $186.21	Professional	TC	$112.20	$123.03	$186.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $269.15 / $426.58	Professional		$120.23	$269.15	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $64.57 / $112.20	Professional	26	$36.31	$64.57	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $181.97 / $331.13	Professional	TC	$81.28	$181.97	$331.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $154.88 / $190.55	Professional		$125.89	$154.88	$190.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $52.48 / $67.61	Professional	26	$42.66	$52.48	$67.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $100.00 / $128.82	Professional	TC	$83.18	$100.00	$128.82
Medcost Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $436.52 / $457.09	Professional		$302.00	$436.52	$457.09
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $102.33 / $102.33	Professional	26	$81.28	$102.33	$102.33
Medcost Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $218.78 / $223.87	Professional		$218.78	$218.78	$223.87
Sentara Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $204.17 / $1,047.13	Professional		$61.66	$204.17	$1,047.13
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $64.57 / $107.15	Professional	26	$48.98	$64.57	$107.15
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $151.36 / $275.42	Professional	TC	$93.33	$151.36	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $218.78 / $416.87	Professional		$123.03	$218.78	$416.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $56.23 / $100.00	Professional	26	$34.67	$56.23	$100.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $154.88 / $338.84	Professional	TC	$83.18	$154.88	$338.84