Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $52.48 / $190.55	Facility	26	$25.70	$52.48	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $70.79 / $194.98	Professional		$54.95	$70.79	$194.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $29.51 / $72.44	Professional	26	$22.91	$29.51	$72.44
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $66.07 / $213.80 / $257.04	Professional	50	$66.07	$213.80	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.02 / $81.28	Professional	TC	$28.84	$38.02	$81.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $91.20 / $134.90	Professional		$67.61	$91.20	$134.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $39.81 / $57.54	Professional	26	$29.51	$39.81	$57.54
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $100.00 / $138.04 / $199.53	Professional	50	$100.00	$138.04	$199.53
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $51.29 / $75.86	Professional	TC	$38.02	$51.29	$75.86
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $75.86 / $281.84	Professional		$48.98	$75.86	$281.84
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $32.36 / $36.31	Professional	26	$28.84	$32.36	$36.31
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $43.65 / $66.07	Professional	TC	$39.81	$43.65	$66.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $33.88 / $48.98	Facility	26	$7.24	$33.88	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $91.20 / $147.91	Professional		$56.23	$91.20	$147.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $35.48 / $66.07	Professional	26	$24.55	$35.48	$66.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $54.95 / $87.10	Professional	TC	$31.62	$54.95	$87.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $79.43 / $100.00	Professional		$63.10	$79.43	$100.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $33.11 / $41.69	Professional	26	$26.30	$33.11	$41.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $46.77 / $57.54	Professional	TC	$37.15	$46.77	$57.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $125.89 / $138.04	Professional		$102.33	$125.89	$138.04
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $48.98 / $54.95	Professional	26	$39.81	$48.98	$54.95
Medcost Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $70.79 / $107.15	Professional		$70.79	$70.79	$107.15
Sentara Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $79.43 / $151.36	Professional		$34.67	$79.43	$151.36
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $39.81 / $60.26	Professional	26	$30.20	$39.81	$60.26
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $56.23 / $83.18	Professional	TC	$38.90	$56.23	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $77.62 / $131.83	Professional		$53.70	$77.62	$131.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $31.62 / $53.70	Professional	26	$21.38	$31.62	$53.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $45.71 / $77.62	Professional	TC	$28.84	$45.71	$77.62