Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.23 / $46.29 / $84.36	Facility	26	$27.23	$46.29	$84.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $97.33 / $176.94	Professional		$89.13	$97.33	$176.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.82 / $29.55 / $63.83	Professional	26	$26.82	$29.55	$63.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.97 / $67.38 / $119.18	Professional	TC	$56.97	$67.38	$119.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.19 / $113.69 / $161.69	Professional		$92.19	$113.69	$161.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.35 / $33.93 / $48.02	Professional	26	$27.35	$33.93	$48.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.03 / $80.83 / $113.72	Professional	TC	$64.03	$80.83	$113.72
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $126.44 / $126.54 / $312.31	Professional		$126.44	$126.54	$312.31
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $33.36 / $35.75 / $67.56	Professional	26	$33.36	$35.75	$67.56
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $90.79 / $90.79 / $171.59	Professional	TC	$90.79	$90.79	$171.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.36 / $34.36 / $34.36	Facility	26	$34.36	$34.36	$34.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $73.76 / $119.79 / $238.17	Professional		$73.76	$119.79	$238.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.15 / $38.88 / $71.42	Professional	26	$24.15	$38.88	$71.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.15 / $84.51 / $165.93	Professional	TC	$48.15	$84.51	$165.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.17 / $118.07 / $140.85	Professional		$95.17	$118.07	$140.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.10 / $34.43 / $42.62	Professional	26	$27.10	$34.43	$42.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.37 / $82.96 / $100.71	Professional	TC	$66.37	$82.96	$100.71
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $45.78 / $53.00 / $93.34	Facility	26	$45.78	$53.00	$93.34
Medcost Facility/Professional Professional Modifier Low / Median / High Price $42.00 / $85.00 / $179.90	Professional		$42.00	$85.00	$179.90
Sentara Facility/Professional Professional Modifier Low / Median / High Price $40.95 / $127.12 / $246.17	Professional		$40.95	$127.12	$246.17
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $32.25 / $42.88 / $68.68	Professional	26	$32.25	$42.88	$68.68
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $67.92 / $107.44 / $166.93	Professional	TC	$67.92	$107.44	$166.93
United Facility/Professional Professional Modifier Low / Median / High Price $79.45 / $122.13 / $180.15	Professional		$79.45	$122.13	$180.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.82 / $37.01 / $54.37	Professional	26	$23.82	$37.01	$54.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.69 / $80.48 / $129.25	Professional	TC	$52.69	$80.48	$129.25