Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.48 / $43.10 / $78.56	Facility	26	$24.48	$43.10	$78.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.44 / $79.53 / $158.37	Professional		$53.44	$79.53	$158.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.46 / $25.01 / $53.74	Professional	26	$23.46	$25.01	$53.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $25.72 / $28.77 / $44.08	Professional	52	$25.72	$28.77	$44.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.89 / $55.00 / $109.16	Professional	TC	$26.89	$55.00	$109.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.55 / $67.20 / $92.74	Professional		$52.55	$67.20	$92.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.58 / $30.69 / $43.11	Professional	26	$24.58	$30.69	$43.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.96 / $35.76 / $54.90	Professional	TC	$27.96	$35.76	$54.90
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $71.86 / $75.78 / $266.67	Professional		$71.86	$75.78	$266.67
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $28.54 / $28.54 / $53.94	Professional	26	$28.54	$28.54	$53.94
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $43.32 / $47.24 / $89.28	Professional	TC	$43.32	$47.24	$89.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.97 / $30.97 / $30.97	Facility	26	$30.97	$30.97	$30.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.41 / $92.22 / $165.07	Professional		$48.41	$92.22	$165.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.72 / $33.84 / $65.06	Professional	26	$21.72	$33.84	$65.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.28 / $60.63 / $101.17	Professional	TC	$26.28	$60.63	$101.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.81 / $67.70 / $82.04	Professional		$54.81	$67.70	$82.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.34 / $30.92 / $38.33	Professional	26	$24.34	$30.92	$38.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.53 / $37.64 / $44.81	Professional	TC	$29.53	$37.64	$44.81
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $39.14 / $46.00 / $80.04	Facility	26	$39.14	$46.00	$80.04
Medcost Facility/Professional Professional Modifier Low / Median / High Price $36.00 / $78.59 / $138.00	Professional		$36.00	$78.59	$138.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $35.24 / $92.80 / $177.10	Professional		$35.24	$92.80	$177.10
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $27.69 / $37.53 / $61.85	Professional	26	$27.69	$37.53	$61.85
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $40.20 / $72.20 / $99.10	Professional	TC	$40.20	$72.20	$99.10
United Facility/Professional Professional Modifier Low / Median / High Price $59.87 / $93.24 / $146.44	Professional		$59.87	$93.24	$146.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.10 / $31.71 / $47.00	Professional	26	$21.10	$31.71	$47.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.70 / $59.98 / $93.54	Professional	TC	$38.70	$59.98	$93.54