Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $50.12 / $128.82	Facility	26	$29.51	$50.12	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $144.54 / $338.84	Professional		$91.20	$144.54	$338.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $44.67 / $123.03	Professional	26	$28.18	$44.67	$123.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $83.18 / $173.78	Professional	TC	$61.66	$83.18	$173.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $138.04 / $213.80	Professional		$102.33	$138.04	$213.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $42.66 / $63.10	Professional	26	$31.62	$42.66	$63.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $95.50 / $144.54	Professional	TC	$70.79	$95.50	$144.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $107.15 / $288.40	Professional		$30.90	$107.15	$288.40
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $34.67 / $47.86	Professional	26	$34.67	$34.67	$47.86
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $83.18 / $125.89	Professional	TC	$70.79	$83.18	$125.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $131.83 / $234.42	Professional		$87.10	$131.83	$234.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $40.74 / $72.44	Professional	26	$26.30	$40.74	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $91.20 / $169.82	Professional	TC	$57.54	$91.20	$169.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $120.23 / $151.36	Professional		$97.72	$120.23	$151.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $35.48 / $44.67	Professional	26	$28.18	$35.48	$44.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $87.10 / $107.15	Professional	TC	$69.18	$87.10	$107.15
Medcost Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $151.36 / $169.82	Professional		$123.03	$151.36	$169.82
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $60.26 / $69.18	Professional	26	$48.98	$60.26	$69.18
Medcost Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $173.78	Professional		$100.00	$100.00	$173.78
Sentara Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $125.89 / $389.05	Professional		$42.66	$125.89	$389.05
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $44.67 / $66.07	Professional	26	$34.67	$44.67	$66.07
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $107.15 / $162.18	Professional	TC	$72.44	$107.15	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $112.20 / $190.55	Professional		$83.18	$112.20	$190.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $34.67 / $58.88	Professional	26	$25.12	$34.67	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $81.28 / $138.04	Professional	TC	$56.23	$81.28	$138.04