Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.70 / $51.26 / $132.41	Facility	26	$28.70	$51.26	$132.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.02 / $79.14 / $124.27	Professional		$66.02	$79.14	$124.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.01 / $30.69 / $50.93	Professional	26	$27.01	$30.69	$50.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.94 / $49.35 / $73.33	Professional	TC	$37.94	$49.35	$73.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.15 / $88.43 / $121.79	Professional		$69.15	$88.43	$121.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.19 / $36.69 / $51.42	Professional	26	$29.19	$36.69	$51.42
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $103.72 / $130.52 / $182.68	Professional	50	$103.72	$130.52	$182.68
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.95 / $51.09 / $70.37	Professional	TC	$39.95	$51.09	$70.37
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $99.95 / $100.37 / $324.07	Professional		$99.95	$100.37	$324.07
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.22 / $38.22 / $72.23	Professional	26	$38.22	$38.22	$72.23
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $61.73 / $61.73 / $116.67	Professional	TC	$61.73	$61.73	$116.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.24 / $36.24 / $36.24	Facility	26	$36.24	$36.24	$36.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.06 / $107.40 / $196.98	Professional		$62.06	$107.40	$196.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.79 / $41.67 / $79.01	Professional	26	$25.79	$41.67	$79.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.90 / $64.53 / $126.61	Professional	TC	$35.90	$64.53	$126.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.84 / $87.52 / $106.74	Professional		$70.84	$87.52	$106.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.23 / $37.00 / $45.63	Professional	26	$29.23	$37.00	$45.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.35 / $51.41 / $63.70	Professional	TC	$40.35	$51.41	$63.70
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $46.00 / $57.75 / $96.81	Facility	26	$46.00	$57.75	$96.81
Medcost Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $81.00 / $142.00	Professional		$45.00	$81.00	$142.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $43.78 / $103.97 / $186.85	Professional		$43.78	$103.97	$186.85
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $35.76 / $46.51 / $73.23	Professional	26	$35.76	$46.51	$73.23
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $53.08 / $71.28 / $118.92	Professional	TC	$53.08	$71.28	$118.92
United Facility/Professional Professional Modifier Low / Median / High Price $69.13 / $116.73 / $172.40	Professional		$69.13	$116.73	$172.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.35 / $39.83 / $66.26	Professional	26	$25.35	$39.83	$66.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.35 / $68.77 / $113.37	Professional	TC	$40.35	$68.77	$113.37