Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.20 / $54.74 / $112.75	Facility	26	$31.20	$54.74	$112.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.45 / $143.77 / $244.93	Professional		$109.45	$143.77	$244.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.19 / $43.61 / $74.41	Professional	26	$31.19	$43.61	$74.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.54 / $105.65 / $166.52	Professional	TC	$79.54	$105.65	$166.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $127.62 / $171.74 / $251.03	Professional		$127.62	$171.74	$251.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.31 / $54.25 / $79.13	Professional	26	$37.31	$54.25	$79.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $88.46 / $117.61 / $172.20	Professional	TC	$88.46	$117.61	$172.20
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $129.21 / $161.03 / $310.20	Professional		$129.21	$161.03	$310.20
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $35.96 / $44.80 / $56.00	Professional	26	$35.96	$44.80	$56.00
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $93.24 / $111.91 / $139.88	Professional	TC	$93.24	$111.91	$139.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.98 / $55.98 / $55.98	Facility	26	$55.98	$55.98	$55.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.64 / $178.50 / $325.69	Professional		$110.64	$178.50	$325.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.52 / $46.65 / $100.57	Professional	26	$34.52	$46.65	$100.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.45 / $127.39 / $225.45	Professional	TC	$76.45	$127.39	$225.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.25 / $173.09 / $213.27	Professional		$144.25	$173.09	$213.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.64 / $53.91 / $65.42	Professional	26	$43.64	$53.91	$65.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.61 / $120.73 / $147.94	Professional	TC	$100.61	$120.73	$147.94
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $49.85 / $57.35 / $119.63	Facility	26	$49.85	$57.35	$119.63
Medcost Facility/Professional Professional Modifier Low / Median / High Price $47.00 / $165.00 / $273.00	Professional		$47.00	$165.00	$273.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $52.73 / $162.85 / $351.82	Professional		$52.73	$162.85	$351.82
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $56.54 / $100.00	Professional	26	$39.79	$56.54	$100.00
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $98.85 / $149.87 / $238.41	Professional	TC	$98.85	$149.87	$238.41
United Facility/Professional Professional Modifier Low / Median / High Price $101.78 / $162.52 / $281.94	Professional		$101.78	$162.52	$281.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.09 / $51.65 / $89.68	Professional	26	$31.09	$51.65	$89.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.16 / $112.88 / $193.95	Professional	TC	$76.16	$112.88	$193.95