Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.40 / $59.63 / $130.77	Facility	26	$40.40	$59.63	$130.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.50 / $80.37 / $189.62	Professional		$70.50	$80.37	$189.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.50 / $40.40 / $72.61	Professional	26	$33.50	$40.40	$72.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.24 / $38.93 / $119.70	Professional	TC	$31.24	$38.93	$119.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $0.02 / $76.98 / $113.03	Professional		$0.02	$76.98	$113.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.69 / $37.43 / $53.19	Professional	26	$19.69	$37.43	$53.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.30 / $41.03 / $63.25	Professional	TC	$25.30	$41.03	$63.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $84.17 / $84.17 / $337.52	Professional		$84.17	$84.17	$337.52
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $37.04 / $41.16 / $52.27	Professional	26	$37.04	$41.16	$52.27
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $43.01 / $43.01 / $81.29	Professional	TC	$43.01	$43.01	$81.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.19 / $43.19 / $43.19	Facility	26	$43.19	$43.19	$43.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.39 / $114.88 / $219.12	Professional		$63.39	$114.88	$219.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.22 / $49.16 / $82.79	Professional	26	$30.22	$49.16	$82.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.02 / $57.13 / $152.94	Professional	TC	$30.02	$57.13	$152.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.03 / $90.92 / $107.02	Professional		$75.03	$90.92	$107.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.75 / $41.69 / $50.24	Professional	26	$33.75	$41.69	$50.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.28 / $49.54 / $58.28	Professional	TC	$41.28	$49.54	$58.28
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $43.90 / $68.30 / $117.13	Facility	26	$43.90	$68.30	$117.13
Medcost Facility/Professional Professional Modifier Low / Median / High Price $44.00 / $75.00 / $150.00	Professional		$44.00	$75.00	$150.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $46.94 / $100.08 / $196.06	Professional		$46.94	$100.08	$196.06
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $39.44 / $53.70 / $84.58	Professional	26	$39.44	$53.70	$84.58
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $39.15 / $56.76 / $123.14	Professional	TC	$39.15	$56.76	$123.14
United Facility/Professional Professional Modifier Low / Median / High Price $58.14 / $97.02 / $242.37	Professional		$58.14	$97.02	$242.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.79 / $48.61 / $77.00	Professional	26	$29.79	$48.61	$77.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.73 / $45.47 / $165.86	Professional	TC	$25.73	$45.47	$165.86