Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.04 / $62.37 / $175.71	Facility	26	$35.04	$62.37	$175.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $132.49 / $151.03 / $304.17	Professional		$132.49	$151.03	$304.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.10 / $38.69 / $85.25	Professional	26	$32.10	$38.69	$85.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $92.82 / $112.34 / $230.90	Professional	TC	$92.82	$112.34	$230.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.44 / $73.44 / $118.04	Professional		$73.44	$73.44	$118.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.60 / $22.60 / $37.60	Professional	26	$22.60	$22.60	$37.60
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.86 / $54.86 / $86.15	Professional	TC	$54.86	$54.86	$86.15
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $113.92 / $177.38 / $234.11	Professional		$113.92	$177.38	$234.11
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $48.39 / $48.39 / $94.36	Professional	26	$48.39	$48.39	$94.36
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $128.99 / $128.99 / $251.53	Professional	TC	$128.99	$128.99	$251.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.90 / $108.32 / $294.54	Professional		$74.90	$108.32	$294.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.78 / $29.57 / $82.02	Professional	26	$19.78	$29.57	$82.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.59 / $79.83 / $231.02	Professional	TC	$45.59	$79.83	$231.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $166.44 / $233.02 / $288.62	Professional		$166.44	$233.02	$288.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.90 / $52.31 / $83.52	Professional	26	$39.90	$52.31	$83.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $126.53 / $177.14 / $196.30	Professional	TC	$126.53	$177.14	$196.30
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $69.31 / $80.86 / $150.00	Facility	26	$69.31	$80.86	$150.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $60.00 / $164.00 / $330.00	Professional		$60.00	$164.00	$330.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $52.50 / $182.39 / $445.71	Professional		$52.50	$182.39	$445.71
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $39.90 / $69.52 / $106.09	Professional	26	$39.90	$69.52	$106.09
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $99.04 / $177.22 / $334.54	Professional	TC	$99.04	$177.22	$334.54
United Facility/Professional Professional Modifier Low / Median / High Price $90.19 / $164.06 / $278.92	Professional		$90.19	$164.06	$278.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.39 / $45.52 / $91.92	Professional	26	$27.39	$45.52	$91.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.46 / $108.20 / $193.52	Professional	TC	$46.46	$108.20	$193.52