Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.60 / $38.10 / $107.67	Facility	26	$29.60	$38.10	$107.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.69 / $75.43 / $106.30	Professional		$64.69	$75.43	$106.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.96 / $31.61 / $50.50	Professional	26	$26.96	$31.61	$50.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.01 / $44.97 / $64.05	Professional	TC	$40.01	$44.97	$64.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.25 / $94.49 / $141.97	Professional		$74.25	$94.49	$141.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.46 / $37.59 / $56.22	Professional	26	$29.46	$37.59	$56.22
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.23 / $57.00 / $84.75	Professional	TC	$44.23	$57.00	$84.75
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $97.89 / $97.95 / $446.87	Professional		$97.89	$97.95	$446.87
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $39.28 / $39.34 / $49.96	Professional	26	$39.28	$39.34	$49.96
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $58.61 / $58.61 / $74.43	Professional	TC	$58.61	$58.61	$74.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $37.82 / $37.82	Facility	26	$37.82	$37.82	$37.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.56 / $106.11 / $180.55	Professional		$65.56	$106.11	$180.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.51 / $43.49 / $72.67	Professional	26	$26.51	$43.49	$72.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.67 / $59.77 / $106.23	Professional	TC	$39.67	$59.77	$106.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $77.33 / $93.24 / $113.73	Professional		$77.33	$93.24	$113.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.82 / $36.83 / $44.27	Professional	26	$29.82	$36.83	$44.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.52 / $57.02 / $69.88	Professional	TC	$47.52	$57.02	$69.88
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $51.68 / $52.22 / $93.07	Facility	26	$51.68	$52.22	$93.07
Medcost Facility/Professional Professional Modifier Low / Median / High Price $49.85 / $86.00 / $151.00	Professional		$49.85	$86.00	$151.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $44.43 / $98.06 / $163.94	Professional		$44.43	$98.06	$163.94
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $35.54 / $47.19 / $74.73	Professional	26	$35.54	$47.19	$74.73
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $47.56 / $67.73 / $107.83	Professional	TC	$47.56	$67.73	$107.83
United Facility/Professional Professional Modifier Low / Median / High Price $66.48 / $99.73 / $164.86	Professional		$66.48	$99.73	$164.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.26 / $42.65 / $67.03	Professional	26	$27.26	$42.65	$67.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.79 / $57.08 / $94.11	Professional	TC	$37.79	$57.08	$94.11