Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.34 / $27.73 / $100.66	Facility	26	$23.34	$27.73	$100.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.79 / $132.72 / $196.70	Professional		$104.79	$132.72	$196.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.79 / $27.73 / $39.36	Professional	26	$22.79	$27.73	$39.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.58 / $109.21 / $160.69	Professional	TC	$72.58	$109.21	$160.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.09 / $184.97 / $259.82	Professional		$134.09	$184.97	$259.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.43 / $28.69 / $39.83	Professional	26	$22.43	$28.69	$39.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.09 / $156.78 / $220.21	Professional	TC	$110.09	$156.78	$220.21
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $179.37 / $199.30 / $643.97	Professional		$179.37	$199.30	$643.97
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.05 / $30.05 / $56.79	Professional	26	$30.05	$30.05	$56.79
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $152.33 / $169.25 / $319.88	Professional	TC	$152.33	$169.25	$319.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.43 / $39.43 / $39.43	Facility	26	$39.43	$39.43	$39.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.90 / $230.12 / $368.91	Professional		$151.90	$230.12	$368.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.23 / $36.94 / $60.33	Professional	26	$26.23	$36.94	$60.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.84 / $192.26 / $314.86	Professional	TC	$122.84	$192.26	$314.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $153.71 / $192.15 / $232.31	Professional		$153.71	$192.15	$232.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.00 / $39.53 / $50.13	Professional	26	$32.00	$39.53	$50.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $119.85 / $152.61 / $198.96	Professional	TC	$119.85	$152.61	$198.96
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $32.76 / $53.00 / $83.46	Facility	26	$32.76	$53.00	$83.46
Medcost Facility/Professional Professional Modifier Low / Median / High Price $36.00 / $185.00 / $316.00	Professional		$36.00	$185.00	$316.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $40.82 / $167.62 / $278.33	Professional		$40.82	$167.62	$278.33
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $29.32 / $40.15 / $58.49	Professional	26	$29.32	$40.15	$58.49
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $99.61 / $153.83 / $251.98	Professional	TC	$99.61	$153.83	$251.98
United Facility/Professional Professional Modifier Low / Median / High Price $137.25 / $211.46 / $341.88	Professional		$137.25	$211.46	$341.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.54 / $33.86 / $53.04	Professional	26	$22.54	$33.86	$53.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.82 / $178.45 / $280.43	Professional	TC	$109.82	$178.45	$280.43