Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $25.70 / $97.72	Facility	26	$12.88	$25.70	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $89.13 / $162.18	Professional		$64.57	$89.13	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $14.13 / $30.20	Professional	26	$10.96	$14.13	$30.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $131.83 / $208.93	Professional		$81.28	$131.83	$208.93
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $19.50 / $29.51	Professional	26	$14.13	$19.50	$29.51
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $114.82 / $208.93	Professional		$14.45	$114.82	$208.93
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $17.78 / $22.39	Professional	26	$15.49	$17.78	$22.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.72 / $17.38 / $24.55	Facility	26	$3.72	$17.38	$24.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $97.72 / $199.53	Professional		$69.18	$97.72	$199.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $19.05 / $32.36	Professional	26	$11.75	$19.05	$32.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $120.23 / $147.91	Professional		$97.72	$120.23	$147.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $17.78 / $22.39	Professional	26	$14.13	$17.78	$22.39
Medcost Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $104.71 / $208.93	Professional		$83.18	$104.71	$208.93
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $27.54 / $30.90	Professional	26	$21.88	$27.54	$30.90
Medcost Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $154.88	Professional		$50.12	$50.12	$154.88
Sentara Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $93.33 / $223.87	Professional		$19.05	$93.33	$223.87
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.50 / $32.36	Professional	26	$15.14	$19.50	$32.36
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $95.50 / $165.96	Professional		$57.54	$95.50	$165.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $16.98 / $30.20	Professional	26	$11.22	$16.98	$30.20