Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $42.66 / $114.82	Facility	26	$25.12	$42.66	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $117.49 / $251.19	Professional		$89.13	$117.49	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $26.92 / $60.26	Professional	26	$20.89	$26.92	$60.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $91.20 / $154.88	Professional	TC	$70.79	$91.20	$154.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $165.96 / $251.19	Professional		$104.71	$165.96	$251.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $36.31 / $56.23	Professional	26	$26.30	$36.31	$56.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $128.82 / $199.53	Professional	TC	$81.28	$128.82	$199.53
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $141.25 / $389.05	Professional		$43.65	$141.25	$389.05
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $29.51 / $41.69	Professional	26	$26.92	$29.51	$41.69
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $112.20 / $158.49	Professional	TC	$95.50	$112.20	$158.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	26	$6.76	$31.62	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $134.90 / $263.03	Professional		$95.50	$134.90	$263.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $33.88 / $60.26	Professional	26	$21.88	$33.88	$60.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $100.00 / $208.93	Professional	TC	$69.18	$100.00	$208.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $158.49 / $194.98	Professional		$131.83	$158.49	$194.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $32.36 / $40.74	Professional	26	$26.30	$32.36	$40.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $125.89 / $154.88	Professional	TC	$102.33	$125.89	$154.88
Medcost Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $173.78 / $295.12	Professional		$138.04	$173.78	$295.12
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $47.86 / $61.66	Professional	26	$38.90	$47.86	$61.66
Medcost Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $218.78	Professional		$128.82	$128.82	$218.78
Sentara Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $123.03 / $316.23	Professional		$35.48	$123.03	$316.23
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $36.31 / $63.10	Professional	26	$27.54	$36.31	$63.10
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $112.20 / $218.78	Professional	TC	$77.62	$112.20	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $131.83 / $229.09	Professional		$83.18	$131.83	$229.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $31.62 / $56.23	Professional	26	$21.38	$31.62	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $97.72 / $173.78	Professional	TC	$63.10	$97.72	$173.78