Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.75 / $38.61 / $67.09	Facility	26	$25.75	$38.61	$67.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.81 / $91.09 / $170.63	Professional		$76.81	$91.09	$170.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.29 / $30.55 / $57.00	Professional	26	$20.29	$30.55	$57.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.95 / $67.38 / $119.18	Professional	TC	$55.95	$67.38	$119.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.81 / $108.93 / $159.35	Professional		$79.81	$108.93	$159.35
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.62 / $31.47 / $45.91	Professional	26	$24.62	$31.47	$45.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.16 / $77.45 / $113.50	Professional	TC	$55.16	$77.45	$113.50
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $100.10 / $104.46 / $211.87	Professional		$100.10	$104.46	$211.87
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $24.10 / $26.13 / $32.65	Professional	26	$24.10	$26.13	$32.65
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $68.39 / $75.98 / $96.51	Professional	TC	$68.39	$75.98	$96.51
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.77 / $107.41 / $207.16	Professional		$71.77	$107.41	$207.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.73 / $31.33 / $60.48	Professional	26	$20.73	$31.33	$60.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.04 / $78.27 / $147.02	Professional	TC	$51.04	$78.27	$147.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $92.13 / $110.56 / $135.75	Professional		$92.13	$110.56	$135.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.61 / $31.64 / $38.63	Professional	26	$25.61	$31.64	$38.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.52 / $79.83 / $97.83	Professional	TC	$66.52	$79.83	$97.83
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $33.40 / $38.00 / $80.70	Facility	26	$33.40	$38.00	$80.70
Medcost Facility/Professional Professional Modifier Low / Median / High Price $31.00 / $95.00 / $161.00	Professional		$31.00	$95.00	$161.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $34.77 / $105.71 / $223.37	Professional		$34.77	$105.71	$223.37
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $25.37 / $35.10 / $64.87	Professional	26	$25.37	$35.10	$64.87
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $65.29 / $94.42 / $151.47	Professional	TC	$65.29	$94.42	$151.47
United Facility/Professional Professional Modifier Low / Median / High Price $66.80 / $101.85 / $177.51	Professional		$66.80	$101.85	$177.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.22 / $32.60 / $52.16	Professional	26	$20.22	$32.60	$52.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.20 / $71.77 / $130.34	Professional	TC	$46.20	$71.77	$130.34