Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.52 / $55.86 / $100.12	Facility	26	$31.52	$55.86	$100.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.30 / $114.13 / $202.59	Professional		$96.30	$114.13	$202.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $34.11 / $63.24	Professional	26	$29.91	$34.11	$63.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.56 / $77.77 / $143.43	Professional	TC	$68.56	$77.77	$143.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.77 / $137.38 / $200.81	Professional		$100.77	$137.38	$200.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $42.33 / $64.95	Professional	26	$33.97	$42.33	$64.95
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.63 / $94.95 / $139.16	Professional	TC	$67.63	$94.95	$139.16
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $126.56 / $128.68 / $279.26	Professional		$126.56	$128.68	$279.26
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $36.36 / $36.77 / $46.19	Professional	26	$36.36	$36.77	$46.19
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $81.31 / $90.35 / $114.54	Professional	TC	$81.31	$90.35	$114.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $43.57 / $43.57	Facility	26	$43.57	$43.57	$43.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.51 / $136.60 / $259.56	Professional		$92.51	$136.60	$259.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.26 / $44.91 / $81.18	Professional	26	$29.26	$44.91	$81.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.53 / $94.74 / $181.71	Professional	TC	$61.53	$94.74	$181.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $115.63 / $138.76 / $170.67	Professional		$115.63	$138.76	$170.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.36 / $42.45 / $51.17	Professional	26	$34.36	$42.45	$51.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.27 / $97.52 / $119.51	Professional	TC	$81.27	$97.52	$119.51
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $49.85 / $57.00 / $118.91	Facility	26	$49.85	$57.00	$118.91
Medcost Facility/Professional Professional Modifier Low / Median / High Price $47.00 / $111.00 / $198.00	Professional		$47.00	$111.00	$198.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $47.76 / $135.72 / $277.05	Professional		$47.76	$135.72	$277.05
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $36.53 / $51.04 / $85.34	Professional	26	$36.53	$51.04	$85.34
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $78.87 / $114.31 / $185.14	Professional	TC	$78.87	$114.31	$185.14
United Facility/Professional Professional Modifier Low / Median / High Price $87.94 / $126.84 / $220.13	Professional		$87.94	$126.84	$220.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.69 / $45.43 / $70.55	Professional	26	$29.69	$45.43	$70.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.90 / $82.77 / $145.31	Professional	TC	$55.90	$82.77	$145.31