Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.40 / $72.93 / $126.20	Facility	26	$41.40	$72.93	$126.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.58 / $59.82 / $114.79	Professional		$55.58	$59.82	$114.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.99 / $41.40 / $80.22	Professional	26	$37.99	$41.40	$80.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.05 / $18.76 / $33.52	Professional	TC	$17.05	$18.76	$33.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.93 / $75.98 / $115.05	Professional		$59.93	$75.98	$115.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.10 / $53.66 / $80.83	Professional	26	$42.10	$53.66	$80.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $22.51 / $34.22	Professional	TC	$17.78	$22.51	$34.22
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $68.45 / $68.53 / $230.96	Professional		$68.45	$68.53	$230.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $46.47 / $46.47 / $46.85	Professional	26	$46.47	$46.47	$46.85
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $21.67 / $22.00 / $22.00	Professional	TC	$21.67	$22.00	$22.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.32 / $52.32 / $52.32	Facility	26	$52.32	$52.32	$52.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.07 / $85.39 / $160.44	Professional		$55.07	$85.39	$160.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $60.38 / $112.76	Professional	26	$39.81	$60.38	$112.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.94 / $25.54 / $47.05	Professional	TC	$16.94	$25.54	$47.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.56 / $85.82 / $90.15	Professional		$64.56	$85.82	$90.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.51 / $59.71 / $65.79	Professional	26	$45.51	$59.71	$65.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $26.61 / $27.22	Professional	TC	$19.05	$26.61	$27.22
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $53.10 / $72.00 / $135.63	Facility	26	$53.10	$72.00	$135.63
Medcost Facility/Professional Professional Modifier Low / Median / High Price $25.00 / $64.00 / $109.00	Professional		$25.00	$64.00	$109.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $23.88 / $73.09 / $158.38	Professional		$23.88	$73.09	$158.38
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $45.70 / $65.18 / $100.48	Professional	26	$45.70	$65.18	$100.48
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $19.07 / $27.83 / $42.23	Professional	TC	$19.07	$27.83	$42.23
United Facility/Professional Professional Modifier Low / Median / High Price $52.77 / $81.81 / $122.66	Professional		$52.77	$81.81	$122.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.83 / $56.45 / $85.19	Professional	26	$35.83	$56.45	$85.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $22.92 / $35.82	Professional	TC	$15.14	$22.92	$35.82