Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.76 / $38.69 / $72.09	Facility	26	$22.76	$38.69	$72.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.73 / $113.67 / $184.75	Professional		$89.73	$113.67	$184.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.28 / $24.20 / $53.32	Professional	26	$21.28	$24.20	$53.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.02 / $90.62 / $149.05	Professional	TC	$69.02	$90.62	$149.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $94.68 / $139.44 / $204.09	Professional		$94.68	$139.44	$204.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.55 / $28.83 / $43.46	Professional	26	$22.55	$28.83	$43.46
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.44 / $111.32 / $163.16	Professional	TC	$69.44	$111.32	$163.16
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $100.90 / $157.46 / $273.18	Professional		$100.90	$157.46	$273.18
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $27.83 / $29.80 / $37.85	Professional	26	$27.83	$29.80	$37.85
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $73.06 / $127.37 / $161.76	Professional	TC	$73.06	$127.37	$161.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.92 / $28.92 / $28.92	Facility	26	$28.92	$28.92	$28.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.37 / $126.08 / $268.42	Professional		$84.37	$126.08	$268.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.27 / $33.28 / $56.86	Professional	26	$20.27	$33.28	$56.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.30 / $96.55 / $216.17	Professional	TC	$58.30	$96.55	$216.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.63 / $141.16 / $172.99	Professional		$117.63	$141.16	$172.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.59 / $27.91 / $34.14	Professional	26	$22.59	$27.91	$34.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.04 / $114.05 / $139.76	Professional	TC	$95.04	$114.05	$139.76
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $38.43 / $45.00 / $78.72	Facility	26	$38.43	$45.00	$78.72
Medcost Facility/Professional Professional Modifier Low / Median / High Price $35.00 / $124.00 / $192.09	Professional		$35.00	$124.00	$192.09
Sentara Facility/Professional Professional Modifier Low / Median / High Price $36.27 / $120.12 / $295.08	Professional		$36.27	$120.12	$295.08
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $26.54 / $36.19 / $57.31	Professional	26	$26.54	$36.19	$57.31
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $75.42 / $123.96 / $234.20	Professional	TC	$75.42	$123.96	$234.20
United Facility/Professional Professional Modifier Low / Median / High Price $74.51 / $130.59 / $236.47	Professional		$74.51	$130.59	$236.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.94 / $29.95 / $48.92	Professional	26	$19.94	$29.95	$48.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.96 / $103.33 / $187.74	Professional	TC	$50.96	$103.33	$187.74