Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.27 / $26.24 / $95.25	Facility	26	$21.27	$26.24	$95.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $116.36 / $135.53 / $233.71	Professional		$116.36	$135.53	$233.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.12 / $26.24 / $45.14	Professional	26	$16.12	$26.24	$45.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.56 / $109.29 / $188.56	Professional	TC	$94.56	$109.29	$188.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $111.53 / $143.46 / $201.23	Professional		$111.53	$143.46	$201.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.27 / $26.68 / $37.42	Professional	26	$20.27	$26.68	$37.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $91.64 / $116.79 / $163.80	Professional	TC	$91.64	$116.79	$163.80
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $127.54 / $144.91 / $507.11	Professional		$127.54	$144.91	$507.11
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $19.36 / $21.51 / $40.65	Professional	26	$19.36	$21.51	$40.65
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $106.03 / $106.03 / $200.40	Professional	TC	$106.03	$106.03	$200.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.70 / $26.70 / $26.70	Facility	26	$26.70	$26.70	$26.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.06 / $178.46 / $289.81	Professional		$120.06	$178.46	$289.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.57 / $25.07 / $55.36	Professional	26	$17.57	$25.07	$55.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.73 / $153.87 / $237.20	Professional	TC	$97.73	$153.87	$237.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $116.34 / $145.83 / $179.48	Professional		$116.34	$145.83	$179.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.39 / $25.92 / $32.03	Professional	26	$20.39	$25.92	$32.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $94.70 / $120.62 / $149.10	Professional	TC	$94.70	$120.62	$149.10
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $16.39 / $26.00 / $64.40	Facility	26	$16.39	$26.00	$64.40
Medcost Facility/Professional Professional Modifier Low / Median / High Price $26.00 / $161.00 / $255.00	Professional		$26.00	$161.00	$255.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $24.27 / $158.68 / $285.83	Professional		$24.27	$158.68	$285.83
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $18.03 / $27.54 / $52.70	Professional	26	$18.03	$27.54	$52.70
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $115.58 / $153.85 / $238.21	Professional	TC	$115.58	$153.85	$238.21
United Facility/Professional Professional Modifier Low / Median / High Price $109.20 / $175.11 / $279.99	Professional		$109.20	$175.11	$279.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.58 / $24.03 / $49.12	Professional	26	$13.58	$24.03	$49.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.17 / $138.71 / $229.00	Professional	TC	$86.17	$138.71	$229.00