Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.02 / $41.13 / $95.78	Facility	26	$25.02	$41.13	$95.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.61 / $113.77 / $165.17	Professional		$90.61	$113.77	$165.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.95 / $26.37 / $39.24	Professional	26	$21.95	$26.37	$39.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.47 / $88.64 / $120.88	Professional	TC	$66.47	$88.64	$120.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.00 / $144.47 / $211.19	Professional		$97.00	$144.47	$211.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.25 / $31.56 / $48.45	Professional	26	$25.25	$31.56	$48.45
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.51 / $113.12 / $165.35	Professional	TC	$69.51	$113.12	$165.35
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $116.69 / $140.87 / $336.95	Professional		$116.69	$140.87	$336.95
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $31.01 / $31.01 / $39.38	Professional	26	$31.01	$31.01	$39.38
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $85.68 / $109.86 / $137.32	Professional	TC	$85.68	$109.86	$137.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $32.15 / $32.15	Facility	26	$32.15	$32.15	$32.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.08 / $138.05 / $266.16	Professional		$96.08	$138.05	$266.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $35.61 / $62.51	Professional	26	$22.39	$35.61	$62.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.20 / $100.22 / $207.91	Professional	TC	$72.20	$100.22	$207.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.54 / $144.65 / $177.26	Professional		$120.54	$144.65	$177.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.17 / $31.09 / $37.54	Professional	26	$25.17	$31.09	$37.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.36 / $114.43 / $140.24	Professional	TC	$95.36	$114.43	$140.24
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $39.53 / $45.00 / $80.48	Facility	26	$39.53	$45.00	$80.48
Medcost Facility/Professional Professional Modifier Low / Median / High Price $37.01 / $106.00 / $191.00	Professional		$37.01	$106.00	$191.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $37.58 / $129.05 / $266.87	Professional		$37.58	$129.05	$266.87
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $28.07 / $39.50 / $63.29	Professional	26	$28.07	$39.50	$63.29
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $88.49 / $125.09 / $218.47	Professional	TC	$88.49	$125.09	$218.47
United Facility/Professional Professional Modifier Low / Median / High Price $89.02 / $144.65 / $225.18	Professional		$89.02	$144.65	$225.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.69 / $35.79 / $60.61	Professional	26	$22.69	$35.79	$60.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.59 / $97.83 / $168.75	Professional	TC	$64.59	$97.83	$168.75