Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.32 / $39.72 / $95.25	Facility	26	$22.32	$39.72	$95.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $149.26 / $174.30 / $339.78	Professional		$149.26	$174.30	$339.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.06 / $26.24 / $45.14	Professional	26	$22.06	$26.24	$45.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $127.29 / $148.07 / $292.60	Professional	TC	$127.29	$148.07	$292.60
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.51 / $188.64 / $260.36	Professional		$147.51	$188.64	$260.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.25 / $27.31 / $38.20	Professional	26	$21.25	$27.31	$38.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $126.00 / $161.13 / $222.38	Professional	TC	$126.00	$161.13	$222.38
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $208.77 / $208.77 / $699.13	Professional		$208.77	$208.77	$699.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $24.80 / $24.80 / $46.87	Professional	26	$24.80	$24.80	$46.87
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $183.98 / $183.98 / $347.72	Professional	TC	$183.98	$183.98	$347.72
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 $153.22 / $226.67 / $365.21	Professional		$153.22	$226.67	$365.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.07 / $32.09 / $55.36	Professional	26	$23.07	$32.09	$55.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $132.54 / $193.60 / $320.14	Professional	TC	$132.54	$193.60	$320.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.52 / $190.75 / $229.87	Professional		$151.52	$190.75	$229.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.05 / $26.64 / $32.86	Professional	26	$21.05	$26.64	$32.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $129.32 / $164.75 / $197.99	Professional	TC	$129.32	$164.75	$197.99
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $26.65 / $43.00 / $75.54	Facility	26	$26.65	$43.00	$75.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $32.00 / $211.00 / $353.00	Professional		$32.00	$211.00	$353.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $32.96 / $216.69 / $383.77	Professional		$32.96	$216.69	$383.77
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $24.23 / $33.56 / $54.48	Professional	26	$24.23	$33.56	$54.48
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $156.53 / $206.03 / $319.58	Professional	TC	$156.53	$206.03	$319.58
United Facility/Professional Professional Modifier Low / Median / High Price $136.26 / $214.72 / $356.79	Professional		$136.26	$214.72	$356.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $29.54 / $49.11	Professional	26	$19.95	$29.54	$49.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.69 / $184.97 / $305.39	Professional	TC	$114.69	$184.97	$305.39