Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.03 / $42.51 / $90.17	Facility	26	$24.03	$42.51	$90.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.14 / $111.83 / $163.88	Professional		$88.14	$111.83	$163.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.69 / $24.83 / $37.81	Professional	26	$20.69	$24.83	$37.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.90 / $89.42 / $129.77	Professional	TC	$69.90	$89.42	$129.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $101.16 / $147.47 / $215.56	Professional		$101.16	$147.47	$215.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.75 / $29.68 / $45.78	Professional	26	$23.75	$29.68	$45.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $73.09 / $117.98 / $172.45	Professional	TC	$73.09	$117.98	$172.45
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $118.20 / $145.99 / $336.05	Professional		$118.20	$145.99	$336.05
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $28.99 / $29.38 / $37.31	Professional	26	$28.99	$29.38	$37.31
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $88.82 / $108.83 / $136.04	Professional	TC	$88.82	$108.83	$136.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.37 / $30.37 / $30.37	Facility	26	$30.37	$30.37	$30.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.05 / $141.90 / $262.31	Professional		$97.05	$141.90	$262.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.32 / $34.20 / $60.04	Professional	26	$21.32	$34.20	$60.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.58 / $105.03 / $206.33	Professional	TC	$75.58	$105.03	$206.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.13 / $150.15 / $184.01	Professional		$125.13	$150.15	$184.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.19 / $29.88 / $36.04	Professional	26	$24.19	$29.88	$36.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.94 / $121.13 / $148.44	Professional	TC	$100.94	$121.13	$148.44
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $39.45 / $45.00 / $79.83	Facility	26	$39.45	$45.00	$79.83
Medcost Facility/Professional Professional Modifier Low / Median / High Price $36.49 / $114.00 / $192.00	Professional		$36.49	$114.00	$192.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $37.28 / $130.16 / $262.14	Professional		$37.28	$130.16	$262.14
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $27.07 / $38.10 / $60.33	Professional	26	$27.07	$38.10	$60.33
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $92.25 / $126.63 / $216.80	Professional	TC	$92.25	$126.63	$216.80
United Facility/Professional Professional Modifier Low / Median / High Price $89.02 / $144.21 / $229.43	Professional		$89.02	$144.21	$229.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.76 / $33.58 / $50.97	Professional	26	$21.76	$33.58	$50.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.98 / $106.01 / $168.21	Professional	TC	$69.98	$106.01	$168.21