Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.58 / $40.79 / $105.61	Facility	26	$15.58	$40.79	$105.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.98 / $91.49 / $179.32	Professional		$72.98	$91.49	$179.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.58 / $38.31 / $58.33	Professional	26	$15.58	$38.31	$58.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.48 / $58.17 / $148.76	Professional	TC	$44.48	$58.17	$148.76
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.78 / $113.58 / $187.78	Professional		$87.78	$113.58	$187.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.30 / $50.77 / $74.22	Professional	26	$23.30	$50.77	$74.22
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.02 / $60.13 / $125.47	Professional	TC	$47.02	$60.13	$125.47
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $112.65 / $127.89 / $1,593.79	Professional		$112.65	$127.89	$1,593.79
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $18.89 / $54.30 / $69.48	Professional	26	$18.89	$54.30	$69.48
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $72.84 / $73.17 / $138.29	Professional	TC	$72.84	$73.17	$138.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.72 / $52.72 / $52.72	Facility	26	$52.72	$52.72	$52.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.34 / $148.49 / $599.11	Professional		$75.34	$148.49	$599.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $32.96 / $94.09	Professional	26	$17.78	$32.96	$94.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.96 / $98.61 / $548.17	Professional	TC	$40.96	$98.61	$548.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $90.26 / $109.61 / $135.18	Professional		$90.26	$109.61	$135.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.77 / $50.37 / $61.20	Professional	26	$40.77	$50.37	$61.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $49.48 / $59.37 / $72.76	Professional	TC	$49.48	$59.37	$72.76
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $26.13 / $31.00 / $109.38	Facility	26	$26.13	$31.00	$109.38
Medcost Facility/Professional Professional Modifier Low / Median / High Price $24.00 / $106.90 / $285.00	Professional		$24.00	$106.90	$285.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $29.98 / $141.88 / $597.29	Professional		$29.98	$141.88	$597.29
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $20.23 / $45.86 / $100.00	Professional	26	$20.23	$45.86	$100.00
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $59.33 / $96.34 / $246.35	Professional	TC	$59.33	$96.34	$246.35
United Facility/Professional Professional Modifier Low / Median / High Price $86.99 / $133.01 / $585.28	Professional		$86.99	$133.01	$585.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.50 / $39.52 / $83.98	Professional	26	$15.50	$39.52	$83.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.47 / $97.56 / $491.05	Professional	TC	$47.47	$97.56	$491.05