Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.98 / $46.68 / $114.86	Facility	26	$26.98	$46.68	$114.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.35 / $63.85 / $120.03	Professional		$58.35	$63.85	$120.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.68 / $28.36 / $48.36	Professional	26	$25.68	$28.36	$48.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $28.66 / $30.89 / $40.75	Professional	52	$28.66	$30.89	$40.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.97 / $36.86 / $70.55	Professional	TC	$30.97	$36.86	$70.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.69 / $79.19 / $110.10	Professional		$62.69	$79.19	$110.10
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.35 / $34.36 / $47.97	Professional	26	$27.35	$34.36	$47.97
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $94.03 / $118.33 / $165.11	Professional	50	$94.03	$118.33	$165.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.34 / $45.20 / $62.24	Professional	TC	$35.34	$45.20	$62.24
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $89.45 / $89.90 / $272.36	Professional		$89.45	$89.90	$272.36
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $34.71 / $34.71 / $65.59	Professional	26	$34.71	$34.71	$65.59
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $54.74 / $55.19 / $104.31	Professional	TC	$54.74	$55.19	$104.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.35 / $90.97 / $157.63	Professional		$54.35	$90.97	$157.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.05 / $36.40 / $69.91	Professional	26	$24.05	$36.40	$69.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.42 / $54.38 / $87.79	Professional	TC	$30.42	$54.38	$87.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.84 / $80.09 / $96.35	Professional		$64.84	$80.09	$96.35
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.49 / $34.67 / $42.76	Professional	26	$27.49	$34.67	$42.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.21 / $46.15 / $55.30	Professional	TC	$36.21	$46.15	$55.30
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $41.24 / $60.00 / $83.50	Facility	26	$41.24	$60.00	$83.50
Medcost Facility/Professional Professional Modifier Low / Median / High Price $41.39 / $69.23 / $122.00	Professional		$41.39	$69.23	$122.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $35.94 / $85.09 / $140.05	Professional		$35.94	$85.09	$140.05
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $31.25 / $41.96 / $66.59	Professional	26	$31.25	$41.96	$66.59
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $42.88 / $59.09 / $83.03	Professional	TC	$42.88	$59.09	$83.03
United Facility/Professional Professional Modifier Low / Median / High Price $53.21 / $80.81 / $124.19	Professional		$53.21	$80.81	$124.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.62 / $34.90 / $50.94	Professional	26	$21.62	$34.90	$50.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.58 / $46.45 / $75.31	Professional	TC	$28.58	$46.45	$75.31