Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.66 / $40.22 / $73.06	Facility	26	$23.66	$40.22	$73.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.09 / $92.43 / $171.60	Professional		$76.09	$92.43	$171.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.41 / $24.52 / $48.73	Professional	26	$20.41	$24.52	$48.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.86 / $67.09 / $127.47	Professional	TC	$56.86	$67.09	$127.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.97 / $111.87 / $161.63	Professional		$83.97	$111.87	$161.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.37 / $29.92 / $42.58	Professional	26	$22.37	$29.92	$42.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $59.92 / $82.68 / $119.24	Professional	TC	$59.92	$82.68	$119.24
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $110.67 / $110.67 / $287.58	Professional		$110.67	$110.67	$287.58
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $28.18 / $35.79	Professional	26	$28.18	$28.18	$35.79
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $74.23 / $82.49 / $104.76	Professional	TC	$74.23	$82.49	$104.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.07 / $30.07 / $30.07	Facility	26	$30.07	$30.07	$30.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.41 / $119.04 / $205.07	Professional		$79.41	$119.04	$205.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.09 / $33.33 / $56.46	Professional	26	$21.09	$33.33	$56.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.22 / $83.47 / $150.75	Professional	TC	$57.22	$83.47	$150.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.26 / $114.31 / $140.09	Professional		$95.26	$114.31	$140.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.50 / $29.03 / $35.50	Professional	26	$23.50	$29.03	$35.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $71.76 / $86.11 / $105.53	Professional	TC	$71.76	$86.11	$105.53
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $30.86 / $45.19 / $92.80	Facility	26	$30.86	$45.19	$92.80
Medcost Facility/Professional Professional Modifier Low / Median / High Price $34.17 / $107.00 / $173.38	Professional		$34.17	$107.00	$173.38
Sentara Facility/Professional Professional Modifier Low / Median / High Price $38.24 / $119.82 / $234.14	Professional		$38.24	$119.82	$234.14
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $26.47 / $40.36 / $65.86	Professional	26	$26.47	$40.36	$65.86
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $67.43 / $109.59 / $173.35	Professional	TC	$67.43	$109.59	$173.35
United Facility/Professional Professional Modifier Low / Median / High Price $74.31 / $113.98 / $175.96	Professional		$74.31	$113.98	$175.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.43 / $31.70 / $52.72	Professional	26	$20.43	$31.70	$52.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.58 / $81.06 / $133.63	Professional	TC	$52.58	$81.06	$133.63