Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.64 / $63.43 / $129.07	Facility	26	$35.64	$63.43	$129.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.52 / $98.28 / $166.34	Professional		$52.52	$98.28	$166.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.64 / $36.49 / $64.69	Professional	26	$35.64	$36.49	$64.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.03 / $62.59 / $111.54	Professional	TC	$16.03	$62.59	$111.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $115.05 / $157.96 / $221.52	Professional		$115.05	$157.96	$221.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.53 / $45.24 / $63.84	Professional	26	$35.53	$45.24	$63.84
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.14 / $112.99 / $158.46	Professional	TC	$87.14	$112.99	$158.46
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $127.69 / $171.17 / $438.75	Professional		$127.69	$171.17	$438.75
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $44.97 / $44.97 / $45.30	Professional	26	$44.97	$44.97	$45.30
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $10.58 / $126.20 / $126.20	Professional	TC	$10.58	$126.20	$126.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.71 / $44.71 / $44.71	Facility	26	$44.71	$44.71	$44.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.81 / $127.87 / $299.91	Professional		$66.81	$127.87	$299.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.57 / $55.22 / $99.65	Professional	26	$34.57	$55.22	$99.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.16 / $86.93 / $203.09	Professional	TC	$14.16	$86.93	$203.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.91 / $184.64 / $193.82	Professional		$134.91	$184.64	$193.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.29 / $51.56 / $56.85	Professional	26	$39.29	$51.56	$56.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.62 / $133.51 / $136.97	Professional	TC	$95.62	$133.51	$136.97
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $46.02 / $70.00 / $116.91	Facility	26	$46.02	$70.00	$116.91
Medcost Facility/Professional Professional Modifier Low / Median / High Price $31.00 / $72.00 / $147.87	Professional		$31.00	$72.00	$147.87
Sentara Facility/Professional Professional Modifier Low / Median / High Price $46.65 / $112.43 / $293.64	Professional		$46.65	$112.43	$293.64
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $42.33 / $58.46 / $91.85	Professional	26	$42.33	$58.46	$91.85
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $10.31 / $118.19 / $206.82	Professional	TC	$10.31	$118.19	$206.82
United Facility/Professional Professional Modifier Low / Median / High Price $62.09 / $146.47 / $221.18	Professional		$62.09	$146.47	$221.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.45 / $52.27 / $73.45	Professional	26	$32.45	$52.27	$73.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.22 / $97.81 / $142.19	Professional	TC	$21.22	$97.81	$142.19