Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $42.66 / $79.43	Facility	26	$28.84	$42.66	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $112.20 / $239.88	Professional		$89.13	$112.20	$239.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $44.67 / $97.72	Professional	26	$28.84	$44.67	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $75.86 / $134.90	Professional	TC	$61.66	$75.86	$134.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $141.25 / $213.80	Professional		$102.33	$141.25	$213.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $41.69 / $64.57	Professional	26	$30.90	$41.69	$64.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $97.72 / $151.36	Professional	TC	$72.44	$97.72	$151.36
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $109.65 / $478.63	Professional		$77.62	$109.65	$478.63
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $35.48 / $48.98	Professional	26	$31.62	$35.48	$48.98
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $120.23 / $131.83	Professional	TC	$97.72	$120.23	$131.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $38.02 / $53.70	Facility	26	$8.13	$38.02	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $138.04 / $234.42	Professional		$87.10	$138.04	$234.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $41.69 / $72.44	Professional	26	$25.70	$41.69	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $91.20 / $165.96	Professional	TC	$60.26	$91.20	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $123.03 / $154.88	Professional		$102.33	$123.03	$154.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $36.31 / $44.67	Professional	26	$29.51	$36.31	$44.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $89.13 / $107.15	Professional	TC	$72.44	$89.13	$107.15
Medcost Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $245.47 / $245.47	Professional		$245.47	$245.47	$245.47
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $70.79 / $70.79	Professional	26	$70.79	$70.79	$70.79
Medcost Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $186.21	Professional		$97.72	$97.72	$186.21
Sentara Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $114.82 / $245.47	Professional		$42.66	$114.82	$245.47
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $43.65 / $74.13	Professional	26	$34.67	$43.65	$74.13
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $97.72 / $169.82	Professional	TC	$74.13	$97.72	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $120.23 / $218.78	Professional		$85.11	$120.23	$218.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $38.90 / $70.79	Professional	26	$26.30	$38.90	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $81.28 / $147.91	Professional	TC	$57.54	$81.28	$147.91