Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.45 / $13.49 / $45.00	Facility	26	$10.45	$13.49	$45.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.98 / $94.71 / $187.31	Professional		$73.98	$94.71	$187.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.45 / $12.36 / $51.30	Professional	26	$10.45	$12.36	$51.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.45 / $83.65 / $130.32	Professional	TC	$61.45	$83.65	$130.32
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.39 / $115.94 / $183.10	Professional		$81.39	$115.94	$183.10
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.76 / $13.71 / $20.81	Professional	26	$10.76	$13.71	$20.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.09 / $102.67 / $163.50	Professional	TC	$64.09	$102.67	$163.50
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $122.51 / $146.22 / $216.57	Professional		$122.51	$146.22	$216.57
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.98 / $14.41 / $16.48	Professional	26	$12.98	$14.41	$16.48
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $109.53 / $121.58 / $139.10	Professional	TC	$109.53	$121.58	$139.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.50 / $13.50 / $13.50	Facility	26	$13.50	$13.50	$13.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.93 / $162.90 / $284.02	Professional		$95.93	$162.90	$284.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.44 / $14.60 / $25.58	Professional	26	$9.44	$14.60	$25.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.29 / $144.21 / $252.10	Professional	TC	$85.29	$144.21	$252.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.38 / $116.85 / $143.19	Professional		$97.38	$116.85	$143.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.54 / $13.02 / $15.68	Professional	26	$10.54	$13.02	$15.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $86.84 / $104.21 / $127.71	Professional	TC	$86.84	$104.21	$127.71
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $13.74 / $19.36 / $36.75	Facility	26	$13.74	$19.36	$36.75
Medcost Facility/Professional Professional Modifier Low / Median / High Price $16.00 / $142.56 / $253.00	Professional		$16.00	$142.56	$253.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $17.16 / $111.78 / $254.17	Professional		$17.16	$111.78	$254.17
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $18.04 / $29.21	Professional	26	$11.78	$18.04	$29.21
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $76.12 / $118.63 / $226.41	Professional	TC	$76.12	$118.63	$226.41
United Facility/Professional Professional Modifier Low / Median / High Price $92.14 / $148.80 / $239.15	Professional		$92.14	$148.80	$239.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.17 / $14.52 / $24.66	Professional	26	$8.17	$14.52	$24.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.08 / $133.38 / $220.26	Professional	TC	$82.08	$133.38	$220.26