Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $23.99 / $28.84	Facility	26	$23.99	$23.99	$28.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $154.88 / $199.53	Professional		$123.03	$154.88	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $128.82 / $165.96	Professional	TC	$100.00	$128.82	$165.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $239.88 / $426.58	Professional		$154.88	$239.88	$426.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $204.17 / $371.54	Professional	TC	$131.83	$204.17	$371.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $165.96 / $263.03	Professional		$30.90	$165.96	$263.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $147.91 / $204.17	Professional	TC	$125.89	$147.91	$204.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.46 / $30.20 / $43.65	Facility	26	$6.46	$30.20	$43.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $194.98 / $363.08	Professional		$89.13	$194.98	$363.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $165.96 / $302.00	Professional	TC	$56.23	$165.96	$302.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $199.53 / $245.47	Professional		$158.49	$199.53	$245.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $29.51 / $38.90	Professional	26	$23.44	$29.51	$38.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $169.82 / $208.93	Professional	TC	$134.90	$169.82	$208.93
Medcost Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $128.82 / $162.18	Professional		$100.00	$128.82	$162.18
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $45.71 / $50.12	Professional	26	$37.15	$45.71	$50.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Professional		$112.20	$112.20	$112.20
Sentara Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $154.88 / $309.03	Professional		$33.11	$154.88	$309.03
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $165.96 / $251.19	Professional	TC	$81.28	$165.96	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $162.18 / $275.42	Professional		$87.10	$162.18	$275.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $128.82 / $223.87	Professional	TC	$53.70	$128.82	$223.87