Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.20 / $55.86 / $98.28	Facility	26	$31.20	$55.86	$98.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.14 / $126.13 / $227.68	Professional		$109.14	$126.13	$227.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $37.63 / $70.45	Professional	26	$29.91	$37.63	$70.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.97 / $90.42 / $164.43	Professional	TC	$78.97	$90.42	$164.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $113.00 / $155.58 / $227.56	Professional		$113.00	$155.58	$227.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.72 / $47.04 / $68.76	Professional	26	$36.72	$47.04	$68.76
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $77.18 / $108.34 / $158.80	Professional	TC	$77.18	$108.34	$158.80
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $129.21 / $146.74 / $302.23	Professional		$129.21	$146.74	$302.23
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $35.96 / $38.65 / $48.31	Professional	26	$35.96	$38.65	$48.31
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $93.24 / $104.04 / $130.05	Professional	TC	$93.24	$104.04	$130.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.64 / $48.64 / $48.64	Facility	26	$48.64	$48.64	$48.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.50 / $152.02 / $296.10	Professional		$102.50	$152.02	$296.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.92 / $45.44 / $86.81	Professional	26	$30.92	$45.44	$86.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $71.43 / $109.94 / $208.26	Professional	TC	$71.43	$109.94	$208.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $130.66 / $156.80 / $192.89	Professional		$130.66	$156.80	$192.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.93 / $46.85 / $56.45	Professional	26	$37.93	$46.85	$56.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.74 / $111.29 / $136.38	Professional	TC	$92.74	$111.29	$136.38
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $49.85 / $58.00 / $118.73	Facility	26	$49.85	$58.00	$118.73
Medcost Facility/Professional Professional Modifier Low / Median / High Price $47.00 / $134.00 / $225.00	Professional		$47.00	$134.00	$225.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $146.16 / $280.10	Professional		$49.00	$146.16	$280.10
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $54.44 / $95.19	Professional	26	$39.79	$54.44	$95.19
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $91.10 / $132.90 / $213.18	Professional	TC	$91.10	$132.90	$213.18
United Facility/Professional Professional Modifier Low / Median / High Price $93.18 / $144.66 / $257.54	Professional		$93.18	$144.66	$257.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.49 / $47.18 / $78.05	Professional	26	$30.49	$47.18	$78.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.14 / $98.15 / $177.04	Professional	TC	$64.14	$98.15	$177.04