Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $56.23 / $204.17	Facility	26	$28.18	$56.23	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $154.88 / $346.74	Professional		$104.71	$154.88	$346.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $41.69 / $102.33	Professional	26	$26.92	$41.69	$102.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $102.33 / $173.78	Professional	TC	$70.79	$102.33	$173.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $263.03 / $371.54	Professional		$141.25	$263.03	$371.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $42.66 / $61.66	Professional	26	$31.62	$42.66	$61.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $218.78 / $316.23	Professional	TC	$102.33	$218.78	$316.23
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $208.93 / $354.81	Professional		$30.90	$208.93	$354.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $33.88 / $52.48	Professional	26	$32.36	$33.88	$52.48
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $190.55 / $223.87	Professional	TC	$169.82	$190.55	$223.87
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 $97.72 / $162.18 / $380.19	Professional		$97.72	$162.18	$380.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $40.74 / $70.79	Professional	26	$26.30	$40.74	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $125.89 / $323.59	Professional	TC	$67.61	$125.89	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $138.04 / $173.78	Professional		$112.20	$138.04	$173.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $34.67 / $43.65	Professional	26	$27.54	$34.67	$43.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $104.71 / $128.82	Professional	TC	$83.18	$104.71	$128.82
Medcost Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $169.82 / $181.97	Professional		$144.54	$169.82	$181.97
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $61.66 / $69.18	Professional	26	$48.98	$61.66	$69.18
Medcost Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $223.87	Professional		$120.23	$120.23	$223.87
Sentara Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $138.04 / $331.13	Professional		$42.66	$138.04	$331.13
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $44.67 / $64.57	Professional	26	$33.88	$44.67	$64.57
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $128.82 / $218.78	Professional	TC	$74.13	$128.82	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $147.91 / $263.03	Professional		$97.72	$147.91	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $34.67 / $58.88	Professional	26	$25.70	$34.67	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $109.65 / $204.17	Professional	TC	$69.18	$109.65	$204.17