Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.02 / $56.99 / $124.94	Facility	26	$32.02	$56.99	$124.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.40 / $98.39 / $183.78	Professional		$82.40	$98.39	$183.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.02 / $35.21 / $73.55	Professional	26	$32.02	$35.21	$73.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.15 / $56.82 / $107.44	Professional	TC	$50.15	$56.82	$107.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.43 / $107.35 / $150.28	Professional		$85.43	$107.35	$150.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.57 / $40.74 / $57.13	Professional	26	$32.57	$40.74	$57.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $52.86 / $66.51 / $92.71	Professional	TC	$52.86	$66.51	$92.71
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $107.04 / $107.04 / $327.36	Professional		$107.04	$107.04	$327.36
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.17 / $40.17 / $75.92	Professional	26	$40.17	$40.17	$75.92
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $66.88 / $66.88 / $126.40	Professional	TC	$66.88	$66.88	$126.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.86 / $40.86 / $40.86	Facility	26	$40.86	$40.86	$40.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.27 / $123.13 / $220.87	Professional		$76.27	$123.13	$220.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.78 / $45.86 / $84.15	Professional	26	$28.78	$45.86	$84.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.81 / $75.26 / $135.24	Professional	TC	$45.81	$75.26	$135.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.32 / $107.87 / $132.94	Professional		$87.32	$107.87	$132.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.93 / $40.58 / $50.25	Professional	26	$31.93	$40.58	$50.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $53.72 / $68.41 / $84.91	Professional	TC	$53.72	$68.41	$84.91
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $52.82 / $63.00 / $109.98	Facility	26	$52.82	$63.00	$109.98
Medcost Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $93.00 / $161.00	Professional		$49.00	$93.00	$161.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $46.34 / $113.84 / $219.17	Professional		$46.34	$113.84	$219.17
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $38.54 / $50.51 / $80.79	Professional	26	$38.54	$50.51	$80.79
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $59.97 / $85.02 / $132.08	Professional	TC	$59.97	$85.02	$132.08
United Facility/Professional Professional Modifier Low / Median / High Price $73.23 / $112.40 / $167.54	Professional		$73.23	$112.40	$167.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.40 / $44.55 / $76.73	Professional	26	$27.40	$44.55	$76.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.15 / $70.34 / $118.19	Professional	TC	$46.15	$70.34	$118.19