Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $66.07 / $194.98	Facility	26	$38.02	$66.07	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $87.10 / $158.49	Professional		$69.18	$87.10	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $48.98 / $131.83	Professional	26	$38.02	$48.98	$131.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $42.66 / $74.13	Professional	TC	$25.12	$42.66	$74.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $109.65 / $173.78	Professional		$79.43	$109.65	$173.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $53.70 / $85.11	Professional	26	$39.81	$53.70	$85.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $56.23 / $89.13	Professional	TC	$39.81	$56.23	$89.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $91.20 / $223.87	Professional		$51.29	$91.20	$223.87
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $42.66 / $60.26	Professional	26	$38.90	$42.66	$60.26
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $48.98 / $67.61	Professional	TC	$43.65	$48.98	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $100.00 / $181.97	Professional		$72.44	$100.00	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $57.54 / $97.72	Professional	26	$40.74	$57.54	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $40.74 / $85.11	Professional	TC	$26.92	$40.74	$85.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $93.33 / $204.17	Professional		$64.57	$93.33	$204.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $44.67 / $95.50	Professional	26	$32.36	$44.67	$95.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $50.12 / $91.20	Professional	TC	$33.11	$50.12	$91.20
Medcost Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $112.20 / $154.88	Professional		$89.13	$112.20	$154.88
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $75.86 / $77.62	Professional	26	$60.26	$75.86	$77.62
Medcost Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Professional		$61.66	$61.66	$61.66
Sentara Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $75.86 / $162.18	Professional		$30.20	$75.86	$162.18
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $56.23 / $93.33	Professional	26	$42.66	$56.23	$93.33
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $41.69 / $87.10	Professional	TC	$23.44	$41.69	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $89.13 / $144.54	Professional		$61.66	$89.13	$144.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $51.29 / $85.11	Professional	26	$36.31	$51.29	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $36.31 / $64.57	Professional	TC	$23.99	$36.31	$64.57