Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.32 / $31.46 / $96.38	Facility	26	$22.32	$31.46	$96.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $116.68 / $135.84 / $261.95	Professional		$116.68	$135.84	$261.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.83 / $24.94 / $41.41	Professional	26	$20.83	$24.94	$41.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.24 / $109.29 / $224.63	Professional	TC	$94.24	$109.29	$224.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.93 / $146.97 / $202.85	Professional		$114.93	$146.97	$202.85
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.04 / $27.30 / $38.00	Professional	26	$21.04	$27.30	$38.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.42 / $119.47 / $165.89	Professional	TC	$93.42	$119.47	$165.89
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $146.09 / $159.27 / $518.73	Professional		$146.09	$159.27	$518.73
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $21.91 / $22.25 / $42.05	Professional	26	$21.91	$22.25	$42.05
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $120.61 / $137.03 / $258.99	Professional	TC	$120.61	$137.03	$258.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.64 / $179.17 / $288.18	Professional		$120.64	$179.17	$288.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.50 / $27.99 / $56.73	Professional	26	$21.50	$27.99	$56.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $98.06 / $147.22 / $238.54	Professional	TC	$98.06	$147.22	$238.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $116.90 / $146.63 / $180.49	Professional		$116.90	$146.63	$180.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.72 / $26.26 / $32.38	Professional	26	$20.72	$26.26	$32.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.02 / $121.03 / $148.61	Professional	TC	$95.02	$121.03	$148.61
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $21.21 / $34.00 / $64.84	Facility	26	$21.21	$34.00	$64.84
Medcost Facility/Professional Professional Modifier Low / Median / High Price $31.00 / $159.00 / $256.00	Professional		$31.00	$159.00	$256.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $28.69 / $169.18 / $294.74	Professional		$28.69	$169.18	$294.74
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $19.96 / $31.25 / $53.37	Professional	26	$19.96	$31.25	$53.37
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $118.64 / $161.38 / $242.50	Professional	TC	$118.64	$161.38	$242.50
United Facility/Professional Professional Modifier Low / Median / High Price $109.23 / $176.40 / $280.10	Professional		$109.23	$176.40	$280.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.85 / $27.81 / $49.70	Professional	26	$17.85	$27.81	$49.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.45 / $138.29 / $227.46	Professional	TC	$86.45	$138.29	$227.46