Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.85 / $38.84 / $117.67	Facility	26	$22.85	$38.84	$117.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.59 / $109.78 / $194.49	Professional		$98.59	$109.78	$194.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.85 / $28.77 / $52.07	Professional	26	$22.85	$28.77	$52.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.65 / $82.79 / $143.59	Professional	TC	$72.65	$82.79	$143.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.36 / $116.33 / $174.51	Professional		$92.36	$116.33	$174.51
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.77 / $28.69 / $43.03	Professional	26	$22.77	$28.69	$43.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.58 / $87.64 / $131.46	Professional	TC	$69.58	$87.64	$131.46
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $103.96 / $115.04 / $348.04	Professional		$103.96	$115.04	$348.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $26.57 / $27.06 / $51.14	Professional	26	$26.57	$27.06	$51.14
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $76.91 / $76.91 / $145.36	Professional	TC	$76.91	$76.91	$145.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.20 / $28.20 / $28.20	Facility	26	$28.20	$28.20	$28.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.08 / $140.85 / $243.63	Professional		$103.08	$140.85	$243.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.85 / $34.95 / $64.41	Professional	26	$24.85	$34.95	$64.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.33 / $106.49 / $180.93	Professional	TC	$76.33	$106.49	$180.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $92.95 / $115.75 / $141.76	Professional		$92.95	$115.75	$141.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.95 / $27.89 / $34.63	Professional	26	$21.95	$27.89	$34.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $69.56 / $88.64 / $109.12	Professional	TC	$69.56	$88.64	$109.12
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $46.00 / $68.48	Facility	26	$29.51	$46.00	$68.48
Medcost Facility/Professional Professional Modifier Low / Median / High Price $33.89 / $122.00 / $181.00	Professional		$33.89	$122.00	$181.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $35.79 / $124.98 / $232.04	Professional		$35.79	$124.98	$232.04
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $27.22 / $35.94 / $55.17	Professional	26	$27.22	$35.94	$55.17
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $81.73 / $108.28 / $169.19	Professional	TC	$81.73	$108.28	$169.19
United Facility/Professional Professional Modifier Low / Median / High Price $83.30 / $129.82 / $200.59	Professional		$83.30	$129.82	$200.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.98 / $30.83 / $51.05	Professional	26	$20.98	$30.83	$51.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.00 / $96.23 / $145.47	Professional	TC	$63.00	$96.23	$145.47