Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.26 / $57.42 / $106.28	Facility	26	$32.26	$57.42	$106.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.91 / $87.68 / $168.46	Professional		$73.91	$87.68	$168.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.25 / $35.61 / $72.88	Professional	26	$32.25	$35.61	$72.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.85 / $48.90 / $94.27	Professional	TC	$40.85	$48.90	$94.27
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $78.98 / $98.77 / $138.52	Professional		$78.98	$98.77	$138.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.18 / $41.50 / $58.20	Professional	26	$33.18	$41.50	$58.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.79 / $57.27 / $80.81	Professional	TC	$45.79	$57.27	$80.81
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $97.13 / $97.13 / $348.06	Professional		$97.13	$97.13	$348.06
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $41.70 / $41.70 / $78.81	Professional	26	$41.70	$41.70	$78.81
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $55.43 / $55.43 / $104.76	Professional	TC	$55.43	$55.43	$104.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.65 / $41.65 / $41.65	Facility	26	$41.65	$41.65	$41.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.59 / $116.66 / $198.98	Professional		$69.59	$116.66	$198.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.45 / $47.37 / $86.54	Professional	26	$29.45	$47.37	$86.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.29 / $67.26 / $118.40	Professional	TC	$40.29	$67.26	$118.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.34 / $100.49 / $121.29	Professional		$81.34	$100.49	$121.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.52 / $41.32 / $51.33	Professional	26	$32.52	$41.32	$51.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.28 / $60.30 / $71.79	Professional	TC	$47.28	$60.30	$71.79
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $54.36 / $65.00 / $111.39	Facility	26	$54.36	$65.00	$111.39
Medcost Facility/Professional Professional Modifier Low / Median / High Price $50.04 / $84.00 / $148.00	Professional		$50.04	$84.00	$148.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $46.23 / $103.83 / $180.02	Professional		$46.23	$103.83	$180.02
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $39.90 / $52.34 / $83.08	Professional	26	$39.90	$52.34	$83.08
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $51.64 / $71.08 / $110.19	Professional	TC	$51.64	$71.08	$110.19
United Facility/Professional Professional Modifier Low / Median / High Price $69.31 / $105.30 / $158.91	Professional		$69.31	$105.30	$158.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.61 / $43.31 / $64.93	Professional	26	$28.61	$43.31	$64.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.89 / $61.15 / $99.72	Professional	TC	$38.89	$61.15	$99.72