Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.86 / $65.38 / $143.47	Facility	26	$35.86	$65.38	$143.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.83 / $104.65 / $216.50	Professional		$96.83	$104.65	$216.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.85 / $39.42 / $81.23	Professional	26	$35.85	$39.42	$81.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.46 / $68.79 / $128.22	Professional	TC	$58.46	$68.79	$128.22
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.21 / $125.81 / $177.86	Professional		$99.21	$125.81	$177.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.07 / $45.91 / $64.67	Professional	26	$36.07	$45.91	$64.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.13 / $79.27 / $113.18	Professional	TC	$63.13	$79.27	$113.18
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $112.61 / $123.67 / $293.92	Professional		$112.61	$123.67	$293.92
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $46.18 / $46.18 / $87.28	Professional	26	$46.18	$46.18	$87.28
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $66.43 / $71.19 / $134.55	Professional	TC	$66.43	$71.19	$134.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.25 / $46.25 / $46.25	Facility	26	$46.25	$46.25	$46.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.95 / $128.10 / $256.82	Professional		$84.95	$128.10	$256.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.72 / $51.78 / $95.30	Professional	26	$32.72	$51.78	$95.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.92 / $79.70 / $163.56	Professional	TC	$49.92	$79.70	$163.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $103.34 / $127.66 / $156.97	Professional		$103.34	$127.66	$156.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.15 / $45.94 / $57.04	Professional	26	$36.15	$45.94	$57.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $65.18 / $82.98 / $103.19	Professional	TC	$65.18	$82.98	$103.19
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $54.89 / $72.00 / $124.61	Facility	26	$54.89	$72.00	$124.61
Medcost Facility/Professional Professional Modifier Low / Median / High Price $56.00 / $105.09 / $183.00	Professional		$56.00	$105.09	$183.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $51.72 / $125.64 / $258.94	Professional		$51.72	$125.64	$258.94
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $43.12 / $57.84 / $91.41	Professional	26	$43.12	$57.84	$91.41
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $70.06 / $92.74 / $160.02	Professional	TC	$70.06	$92.74	$160.02
United Facility/Professional Professional Modifier Low / Median / High Price $78.76 / $121.75 / $194.51	Professional		$78.76	$121.75	$194.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.13 / $50.51 / $71.03	Professional	26	$32.13	$50.51	$71.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.21 / $70.17 / $124.87	Professional	TC	$43.21	$70.17	$124.87