Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.12 / $39.65 / $120.31	Facility	26	$31.12	$39.65	$120.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.79 / $99.25 / $179.93	Professional		$87.79	$99.25	$179.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.06 / $33.90 / $69.43	Professional	26	$30.06	$33.90	$69.43
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $113.20 / $117.39 / $278.89	Professional	50	$113.20	$117.39	$278.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.72 / $68.13 / $122.25	Professional	TC	$59.72	$68.13	$122.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.59 / $119.10 / $166.00	Professional		$92.59	$119.10	$166.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.96 / $39.83 / $55.51	Professional	26	$30.96	$39.83	$55.51
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $138.88 / $177.56 / $249.00	Professional	50	$138.88	$177.56	$249.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $61.63 / $79.28 / $110.50	Professional	TC	$61.63	$79.28	$110.50
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $111.18 / $115.67 / $230.46	Professional		$111.18	$115.67	$230.46
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.03 / $40.03 / $75.66	Professional	26	$40.03	$40.03	$75.66
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $71.15 / $71.15 / $134.47	Professional	TC	$71.15	$71.15	$134.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $39.72 / $39.72	Facility	26	$39.72	$39.72	$39.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.29 / $131.80 / $247.90	Professional		$82.29	$131.80	$247.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.86 / $44.19 / $81.77	Professional	26	$27.86	$44.19	$81.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.54 / $88.23 / $162.11	Professional	TC	$54.54	$88.23	$162.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.45 / $120.50 / $148.87	Professional		$97.45	$120.50	$148.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.35 / $39.83 / $49.18	Professional	26	$31.35	$39.83	$49.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $64.22 / $81.77 / $102.19	Professional	TC	$64.22	$81.77	$102.19
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $54.68 / $54.68 / $105.71	Facility	26	$54.68	$54.68	$105.71
Medcost Facility/Professional Professional Modifier Low / Median / High Price $46.00 / $100.00 / $182.53	Professional		$46.00	$100.00	$182.53
Sentara Facility/Professional Professional Modifier Low / Median / High Price $46.34 / $127.04 / $242.57	Professional		$46.34	$127.04	$242.57
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $37.07 / $49.12 / $77.77	Professional	26	$37.07	$49.12	$77.77
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $70.59 / $97.37 / $156.47	Professional	TC	$70.59	$97.37	$156.47
United Facility/Professional Professional Modifier Low / Median / High Price $83.61 / $129.74 / $196.18	Professional		$83.61	$129.74	$196.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.66 / $40.78 / $62.87	Professional	26	$27.66	$40.78	$62.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.86 / $82.21 / $126.02	Professional	TC	$53.86	$82.21	$126.02