Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.05 / $32.69 / $98.33	Facility	26	$27.05	$32.69	$98.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.58 / $98.26 / $166.06	Professional		$90.58	$98.26	$166.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.50 / $27.05 / $44.38	Professional	26	$24.50	$27.05	$44.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.54 / $71.89 / $119.15	Professional	TC	$65.54	$71.89	$119.15
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $94.98 / $122.13 / $178.72	Professional		$94.98	$122.13	$178.72
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.51 / $32.77 / $46.62	Professional	26	$25.51	$32.77	$46.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.55 / $89.36 / $131.63	Professional	TC	$69.55	$89.36	$131.63
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $128.72 / $128.85 / $321.77	Professional		$128.72	$128.85	$321.77
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $33.59 / $33.59 / $63.49	Professional	26	$33.59	$33.59	$63.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $95.13 / $95.13 / $179.80	Professional	TC	$95.13	$95.13	$179.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Facility	26	$32.36	$32.36	$32.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.22 / $135.79 / $246.29	Professional		$84.22	$135.79	$246.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.73 / $36.01 / $66.64	Professional	26	$22.73	$36.01	$66.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.37 / $96.14 / $176.90	Professional	TC	$61.37	$96.14	$176.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $100.87 / $125.59 / $149.29	Professional		$100.87	$125.59	$149.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.64 / $31.68 / $38.04	Professional	26	$25.64	$31.68	$38.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.70 / $92.13 / $109.08	Professional	TC	$73.70	$92.13	$109.08
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $44.47 / $54.85 / $87.03	Facility	26	$44.47	$54.85	$87.03
Medcost Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $133.75 / $197.00	Professional		$40.00	$133.75	$197.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $37.99 / $126.10 / $213.41	Professional		$37.99	$126.10	$213.41
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $30.39 / $39.81 / $63.37	Professional	26	$30.39	$39.81	$63.37
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $77.80 / $105.39 / $172.44	Professional	TC	$77.80	$105.39	$172.44
United Facility/Professional Professional Modifier Low / Median / High Price $84.75 / $130.55 / $197.41	Professional		$84.75	$130.55	$197.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.73 / $33.11 / $54.65	Professional	26	$21.73	$33.11	$54.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.13 / $94.38 / $150.10	Professional	TC	$62.13	$94.38	$150.10