Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.24 / $76.80 / $137.66	Facility	26	$45.24	$76.80	$137.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.43 / $95.60 / $191.65	Professional		$84.43	$95.60	$191.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $45.24 / $88.93	Professional	26	$40.96	$45.24	$88.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.19 / $54.64 / $80.55	Professional	TC	$39.19	$54.64	$80.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $86.97 / $111.22 / $166.98	Professional		$86.97	$111.22	$166.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.25 / $57.54 / $80.31	Professional	26	$45.25	$57.54	$80.31
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.70 / $51.74 / $73.12	Professional	TC	$40.70	$51.74	$73.12
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $101.49 / $197.91 / $783.40	Professional		$101.49	$197.91	$783.40
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $50.55 / $50.55 / $50.72	Professional	26	$50.55	$50.55	$50.72
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $50.95 / $50.95 / $99.35	Professional	TC	$50.95	$50.95	$99.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.93 / $56.93 / $56.93	Facility	26	$56.93	$56.93	$56.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.98 / $146.85 / $256.99	Professional		$80.98	$146.85	$256.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.06 / $65.18 / $124.53	Professional	26	$43.06	$65.18	$124.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.46 / $71.31 / $183.94	Professional	TC	$39.46	$71.31	$183.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $93.80 / $126.25 / $132.61	Professional		$93.80	$126.25	$132.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $49.45 / $64.84 / $71.51	Professional	26	$49.45	$64.84	$71.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.35 / $61.93 / $63.49	Professional	TC	$44.35	$61.93	$63.49
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $68.27 / $78.00 / $149.71	Facility	26	$68.27	$78.00	$149.71
Medcost Facility/Professional Professional Modifier Low / Median / High Price $59.00 / $94.00 / $175.00	Professional		$59.00	$94.00	$175.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $51.11 / $117.27 / $269.36	Professional		$51.11	$117.27	$269.36
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $50.09 / $71.73 / $109.57	Professional	26	$50.09	$71.73	$109.57
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $45.11 / $69.56 / $148.88	Professional	TC	$45.11	$69.56	$148.88
United Facility/Professional Professional Modifier Low / Median / High Price $83.20 / $137.37 / $271.79	Professional		$83.20	$137.37	$271.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.92 / $62.41 / $94.68	Professional	26	$40.92	$62.41	$94.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.51 / $66.04 / $199.92	Professional	TC	$41.51	$66.04	$199.92