Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.32 / $49.84 / $93.02	Facility	26	$29.32	$49.84	$93.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.95 / $110.77 / $205.63	Professional		$93.95	$110.77	$205.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.32 / $31.55 / $62.84	Professional	26	$29.32	$31.55	$62.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.01 / $72.66 / $139.25	Professional	TC	$64.01	$72.66	$139.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.68 / $120.89 / $170.32	Professional		$96.68	$120.89	$170.32
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.50 / $36.78 / $51.96	Professional	26	$29.50	$36.78	$51.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.76 / $84.20 / $118.57	Professional	TC	$66.76	$84.20	$118.57
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $132.00 / $137.91 / $320.63	Professional		$132.00	$137.91	$320.63
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $35.97 / $35.97 / $68.00	Professional	26	$35.97	$35.97	$68.00
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $96.02 / $101.93 / $192.65	Professional	TC	$96.02	$101.93	$192.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.07 / $37.07 / $37.07	Facility	26	$37.07	$37.07	$37.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.31 / $134.08 / $251.18	Professional		$84.31	$134.08	$251.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.07 / $41.91 / $76.98	Professional	26	$26.07	$41.91	$76.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.01 / $92.19 / $172.30	Professional	TC	$58.01	$92.19	$172.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $99.97 / $123.92 / $152.59	Professional		$99.97	$123.92	$152.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.21 / $37.11 / $45.95	Professional	26	$29.21	$37.11	$45.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $68.92 / $87.83 / $108.61	Professional	TC	$68.92	$87.83	$108.61
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $49.40 / $71.63 / $101.21	Facility	26	$49.40	$71.63	$101.21
Medcost Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $112.00 / $190.00	Professional		$45.00	$112.00	$190.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $44.80 / $132.71 / $257.00	Professional		$44.80	$132.71	$257.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $34.99 / $45.86 / $73.98	Professional	26	$34.99	$45.86	$73.98
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $74.91 / $111.34 / $171.81	Professional	TC	$74.91	$111.34	$171.81
United Facility/Professional Professional Modifier Low / Median / High Price $83.64 / $122.67 / $189.61	Professional		$83.64	$122.67	$189.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.59 / $39.57 / $59.20	Professional	26	$25.59	$39.57	$59.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.84 / $81.37 / $134.26	Professional	TC	$56.84	$81.37	$134.26