Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.33 / $26.08 / $90.27	Facility	26	$23.33	$26.08	$90.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.06 / $101.35 / $183.89	Professional		$86.06	$101.35	$183.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.99 / $24.84 / $45.98	Professional	26	$22.99	$24.84	$45.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.40 / $76.51 / $142.36	Professional	TC	$61.40	$76.51	$142.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.20 / $123.74 / $172.47	Professional		$96.20	$123.74	$172.47
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.66 / $29.77 / $42.01	Professional	26	$23.66	$29.77	$42.01
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $73.05 / $93.97 / $130.97	Professional	TC	$73.05	$93.97	$130.97
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $108.48 / $120.53 / $361.85	Professional		$108.48	$120.53	$361.85
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.87 / $31.14 / $58.85	Professional	26	$30.87	$31.14	$58.85
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $80.69 / $83.17 / $157.19	Professional	TC	$80.69	$83.17	$157.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.72 / $29.72 / $29.72	Facility	26	$29.72	$29.72	$29.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.84 / $123.91 / $254.48	Professional		$82.84	$123.91	$254.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.84 / $33.32 / $61.87	Professional	26	$20.84	$33.32	$61.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.51 / $88.80 / $192.37	Professional	TC	$61.51	$88.80	$192.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $101.88 / $127.00 / $150.78	Professional		$101.88	$127.00	$150.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.17 / $28.62 / $35.00	Professional	26	$23.17	$28.62	$35.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $77.27 / $96.59 / $114.36	Professional	TC	$77.27	$96.59	$114.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $35.79 / $47.45 / $80.77	Facility	26	$35.79	$47.45	$80.77
Medcost Facility/Professional Professional Modifier Low / Median / High Price $35.00 / $94.00 / $188.30	Professional		$35.00	$94.00	$188.30
Sentara Facility/Professional Professional Modifier Low / Median / High Price $35.97 / $113.93 / $242.99	Professional		$35.97	$113.93	$242.99
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $28.10 / $37.32 / $59.57	Professional	26	$28.10	$37.32	$59.57
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $71.95 / $105.74 / $170.40	Professional	TC	$71.95	$105.74	$170.40
United Facility/Professional Professional Modifier Low / Median / High Price $79.40 / $121.79 / $198.46	Professional		$79.40	$121.79	$198.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.45 / $30.97 / $44.63	Professional	26	$20.45	$30.97	$44.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.71 / $85.68 / $152.47	Professional	TC	$58.71	$85.68	$152.47