Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.83 / $26.91 / $50.53	Facility	26	$15.83	$26.91	$50.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $80.70 / $97.79 / $167.90	Professional		$80.70	$97.79	$167.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.40 / $17.53 / $35.83	Professional	26	$15.40	$17.53	$35.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.85 / $81.95 / $139.31	Professional	TC	$63.85	$81.95	$139.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $82.86 / $111.74 / $160.55	Professional		$82.86	$111.74	$160.55
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.93 / $20.27 / $29.60	Professional	26	$15.93	$20.27	$29.60
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.02 / $91.73 / $131.80	Professional	TC	$68.02	$91.73	$131.80
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $126.07 / $132.19 / $309.81	Professional		$126.07	$132.19	$309.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $20.02 / $20.02 / $27.03	Professional	26	$20.02	$20.02	$27.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $106.05 / $112.17 / $151.43	Professional	TC	$106.05	$112.17	$151.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.50 / $20.50 / $20.50	Facility	26	$20.50	$20.50	$20.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $114.47 / $211.90	Professional		$75.86	$114.47	$211.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.24 / $23.33 / $38.65	Professional	26	$14.24	$23.33	$38.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $59.62 / $92.13 / $172.32	Professional	TC	$59.62	$92.13	$172.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $92.47 / $110.96 / $138.13	Professional		$92.47	$110.96	$138.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.26 / $19.51 / $23.75	Professional	26	$16.26	$19.51	$23.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.36 / $91.37 / $114.21	Professional	TC	$75.36	$91.37	$114.21
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $24.35 / $32.15 / $54.75	Facility	26	$24.35	$32.15	$54.75
Medcost Facility/Professional Professional Modifier Low / Median / High Price $24.00 / $104.00 / $174.82	Professional		$24.00	$104.00	$174.82
Sentara Facility/Professional Professional Modifier Low / Median / High Price $24.22 / $116.28 / $203.22	Professional		$24.22	$116.28	$203.22
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $17.73 / $24.78 / $40.63	Professional	26	$17.73	$24.78	$40.63
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $69.36 / $113.18 / $181.08	Professional	TC	$69.36	$113.18	$181.08
United Facility/Professional Professional Modifier Low / Median / High Price $75.17 / $109.33 / $176.04	Professional		$75.17	$109.33	$176.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.35 / $21.40 / $36.11	Professional	26	$14.35	$21.40	$36.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.54 / $81.02 / $145.06	Professional	TC	$61.54	$81.02	$145.06