Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $45.71 / $173.78	Facility	26	$23.99	$45.71	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $125.89 / $363.08	Professional		$72.44	$125.89	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $41.69 / $83.18	Professional	26	$25.70	$41.69	$83.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $85.11 / $218.78	Professional	TC	$47.86	$85.11	$218.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $131.83 / $213.80	Professional		$89.13	$131.83	$213.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $34.67 / $56.23	Professional	26	$25.70	$34.67	$56.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $97.72 / $154.88	Professional	TC	$64.57	$97.72	$154.88
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $128.82 / $190.55	Professional		$97.72	$128.82	$190.55
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $35.48 / $53.70	Professional	26	$31.62	$35.48	$53.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $138.04 / $165.96	Professional	TC	$112.20	$138.04	$165.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	26	$6.76	$31.62	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $128.82 / $257.04	Professional		$83.18	$128.82	$257.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $33.11 / $64.57	Professional	26	$21.38	$33.11	$64.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $89.13 / $186.21	Professional	TC	$60.26	$89.13	$186.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $117.49 / $147.91	Professional		$97.72	$117.49	$147.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.20 / $38.90	Professional	26	$24.55	$30.20	$38.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $87.10 / $112.20	Professional	TC	$70.79	$87.10	$112.20
Medcost Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $141.25 / $229.09	Professional		$114.82	$141.25	$229.09
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $48.98 / $58.88	Professional	26	$38.02	$48.98	$58.88
Medcost Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $165.96	Professional		$72.44	$72.44	$165.96
Sentara Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $79.43 / $245.47	Professional		$31.62	$79.43	$245.47
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $35.48 / $63.10	Professional	26	$26.92	$35.48	$63.10
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $75.86 / $158.49	Professional	TC	$25.70	$75.86	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $114.82 / $208.93	Professional		$67.61	$114.82	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $32.36 / $56.23	Professional	26	$18.62	$32.36	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $83.18 / $151.36	Professional	TC	$48.98	$83.18	$151.36