Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.85 / $44.23 / $94.89	Facility	26	$24.85	$44.23	$94.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.52 / $99.23 / $186.60	Professional		$66.52	$99.23	$186.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.03 / $29.35 / $55.00	Professional	26	$24.03	$29.35	$55.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.50 / $72.05 / $130.58	Professional	TC	$42.50	$72.05	$130.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.50 / $114.86 / $181.14	Professional		$77.50	$114.86	$181.14
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.89 / $30.93 / $47.79	Professional	26	$24.89	$30.93	$47.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $53.29 / $84.56 / $133.35	Professional	TC	$53.29	$84.56	$133.35
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $106.79 / $128.69 / $169.82	Professional		$106.79	$128.69	$169.82
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $29.66 / $29.66 / $37.67	Professional	26	$29.66	$29.66	$37.67
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $77.13 / $77.13 / $107.59	Professional	TC	$77.13	$77.13	$107.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.27 / $31.27 / $31.27	Facility	26	$31.27	$31.27	$31.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.49 / $134.76 / $255.59	Professional		$84.49	$134.76	$255.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.13 / $35.39 / $62.08	Professional	26	$22.13	$35.39	$62.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.90 / $93.61 / $183.52	Professional	TC	$60.90	$93.61	$183.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $98.10 / $117.72 / $144.26	Professional		$98.10	$117.72	$144.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.70 / $30.51 / $37.27	Professional	26	$24.70	$30.51	$37.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.40 / $88.08 / $107.94	Professional	TC	$73.40	$88.08	$107.94
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $39.92 / $40.22 / $84.96	Facility	26	$39.92	$40.22	$84.96
Medcost Facility/Professional Professional Modifier Low / Median / High Price $36.00 / $104.00 / $181.00	Professional		$36.00	$104.00	$181.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $33.97 / $86.91 / $199.85	Professional		$33.97	$86.91	$199.85
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $27.15 / $38.39 / $60.40	Professional	26	$27.15	$38.39	$60.40
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $25.83 / $75.77 / $157.09	Professional	TC	$25.83	$75.77	$157.09
United Facility/Professional Professional Modifier Low / Median / High Price $81.51 / $125.64 / $206.98	Professional		$81.51	$125.64	$206.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.64 / $34.79 / $53.39	Professional	26	$20.64	$34.79	$53.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.45 / $88.93 / $143.04	Professional	TC	$49.45	$88.93	$143.04