Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $38.90 / $147.91	Facility	26	$19.95	$38.90	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $125.89 / $213.80	Professional		$91.20	$125.89	$213.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $22.91 / $48.98	Professional	26	$18.20	$22.91	$48.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $169.82 / $263.03	Professional		$114.82	$169.82	$263.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $30.20 / $45.71	Professional	26	$21.88	$30.20	$45.71
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $151.36 / $309.03	Professional		$23.99	$151.36	$309.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $25.70 / $36.31	Professional	26	$21.88	$25.70	$36.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.62 / $26.30 / $37.15	Facility	26	$5.62	$26.30	$37.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $138.04 / $275.42	Professional		$93.33	$138.04	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $28.84 / $50.12	Professional	26	$17.78	$28.84	$50.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $154.88 / $199.53	Professional		$128.82	$154.88	$199.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $25.70 / $33.11	Professional	26	$20.89	$25.70	$33.11
Medcost Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $144.54 / $295.12	Professional		$114.82	$144.54	$295.12
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $42.66 / $50.12	Professional	26	$33.88	$42.66	$50.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $223.87	Professional		$100.00	$100.00	$223.87
Sentara Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $128.82 / $309.03	Professional		$30.20	$128.82	$309.03
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $30.90 / $51.29	Professional	26	$23.44	$30.90	$51.29
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $128.82 / $234.42	Professional		$83.18	$128.82	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $27.54 / $47.86	Professional	26	$18.20	$27.54	$47.86