Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.00 / $36.82 / $84.35	Facility	26	$32.00	$36.82	$84.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $92.76 / $137.78	Professional		$64.31	$92.76	$137.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $33.90 / $52.16	Professional	26	$28.14	$33.90	$52.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.03 / $57.16 / $93.76	Professional	TC	$33.03	$57.16	$93.76
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $76.56 / $116.73 / $183.93	Professional		$76.56	$116.73	$183.93
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.36 / $38.99 / $59.59	Professional	26	$30.36	$38.99	$59.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.49 / $78.94 / $124.32	Professional	TC	$43.49	$78.94	$124.32
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $95.37 / $105.97 / $206.64	Professional		$95.37	$105.97	$206.64
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $28.93 / $31.35 / $61.13	Professional	26	$28.93	$31.35	$61.13
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $67.15 / $74.62 / $145.51	Professional	TC	$67.15	$74.62	$145.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.74 / $112.02 / $228.79	Professional		$62.74	$112.02	$228.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.50 / $46.34 / $78.97	Professional	26	$32.50	$46.34	$78.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.41 / $70.44 / $149.68	Professional	TC	$19.41	$70.44	$149.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.19 / $116.21 / $148.63	Professional		$97.19	$116.21	$148.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.67 / $37.88 / $46.90	Professional	26	$30.67	$37.88	$46.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.43 / $78.26 / $101.74	Professional	TC	$66.43	$78.26	$101.74
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $32.53 / $43.00 / $88.43	Facility	26	$32.53	$43.00	$88.43
Medcost Facility/Professional Professional Modifier Low / Median / High Price $41.00 / $66.08 / $145.76	Professional		$41.00	$66.08	$145.76
Sentara Facility/Professional Professional Modifier Low / Median / High Price $36.28 / $91.98 / $209.18	Professional		$36.28	$91.98	$209.18
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $34.36 / $48.14 / $77.42	Professional	26	$34.36	$48.14	$77.42
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $39.92 / $87.77 / $144.72	Professional	TC	$39.92	$87.77	$144.72
United Facility/Professional Professional Modifier Low / Median / High Price $52.40 / $95.22 / $185.39	Professional		$52.40	$95.22	$185.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.06 / $45.03 / $69.16	Professional	26	$27.06	$45.03	$69.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.93 / $63.28 / $119.99	Professional	TC	$17.93	$63.28	$119.99