Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $67.61 / $263.03	Facility	26	$35.48	$67.61	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $165.96 / $407.38	Professional		$93.33	$165.96	$407.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $67.61 / $181.97	Professional	26	$34.67	$67.61	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $75.86 / $158.49	Professional	TC	$56.23	$75.86	$158.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $144.54 / $213.80	Professional		$102.33	$144.54	$213.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $52.48 / $77.62	Professional	26	$38.02	$52.48	$77.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $93.33 / $138.04	Professional	TC	$64.57	$93.33	$138.04
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $120.23 / $309.03	Professional		$83.18	$120.23	$309.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $42.66 / $61.66	Professional	26	$38.02	$42.66	$61.66
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $79.43 / $89.13	Professional	TC	$70.79	$79.43	$89.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $45.71 / $66.07	Facility	26	$9.77	$45.71	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $125.89 / $245.47	Professional		$85.11	$125.89	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $51.29 / $89.13	Professional	26	$33.11	$51.29	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $77.62 / $158.49	Professional	TC	$50.12	$77.62	$158.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $128.82 / $158.49	Professional		$102.33	$128.82	$158.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $44.67 / $56.23	Professional	26	$35.48	$44.67	$56.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $83.18 / $102.33	Professional	TC	$66.07	$83.18	$102.33
Medcost Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $131.83 / $141.25	Professional		$114.82	$131.83	$141.25
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $61.66 / $77.62	Professional	26	$61.66	$61.66	$77.62
Medcost Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $177.83	Professional		$50.12	$50.12	$177.83
Sentara Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $114.82 / $281.84	Professional		$51.29	$114.82	$281.84
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $54.95 / $83.18	Professional	26	$41.69	$54.95	$83.18
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $89.13 / $144.54	Professional	TC	$67.61	$89.13	$144.54
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $114.82 / $194.98	Professional		$77.62	$114.82	$194.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $43.65 / $74.13	Professional	26	$30.90	$43.65	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $70.79 / $125.89	Professional	TC	$43.65	$70.79	$125.89