Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $89.13 / $120.23	Facility	26	$51.29	$89.13	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $112.20 / $251.19	Professional		$83.18	$112.20	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $66.07 / $177.83	Professional	26	$51.29	$66.07	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $41.69 / $72.44	Professional	TC	$25.70	$41.69	$72.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $128.82 / $204.17	Professional		$93.33	$128.82	$204.17
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $114.82	Professional	26	$52.48	$72.44	$114.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $56.23 / $89.13	Professional	TC	$40.74	$56.23	$89.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $107.15 / $263.03	Professional		$60.26	$107.15	$263.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $57.54 / $74.13	Professional	26	$52.48	$57.54	$74.13
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $47.86 / $67.61	Professional	TC	$43.65	$47.86	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $117.49 / $218.78	Professional		$87.10	$117.49	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $75.86 / $134.90	Professional	26	$54.95	$75.86	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $40.74 / $85.11	Professional	TC	$28.18	$40.74	$85.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $109.65 / $234.42	Professional		$75.86	$109.65	$234.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $58.88 / $128.82	Professional	26	$42.66	$58.88	$128.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $50.12 / $95.50	Professional	TC	$33.11	$50.12	$95.50
Medcost Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $125.89 / $181.97	Professional		$100.00	$125.89	$181.97
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $89.13 / $104.71	Professional	26	$70.79	$89.13	$104.71
Medcost Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $70.79 / $70.79	Professional		$70.79	$70.79	$70.79
Sentara Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $93.33 / $186.21	Professional		$30.90	$93.33	$186.21
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $69.18 / $125.89	Professional	26	$54.95	$69.18	$125.89
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $41.69 / $85.11	Professional	TC	$23.99	$41.69	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $104.71 / $173.78	Professional		$72.44	$104.71	$173.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $66.07 / $112.20	Professional	26	$47.86	$66.07	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $37.15 / $64.57	Professional	TC	$23.99	$37.15	$64.57