Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.84 / $49.55 / $554.40	Facility	26	$27.84	$49.55	$554.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.15 / $84.79 / $162.08	Professional		$72.15	$84.79	$162.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.64 / $30.58 / $65.22	Professional	26	$27.64	$30.58	$65.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.97 / $52.14 / $98.05	Professional	TC	$43.97	$52.14	$98.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.68 / $93.97 / $131.53	Professional		$74.68	$93.97	$131.53
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.96 / $35.13 / $49.04	Professional	26	$27.96	$35.13	$49.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.71 / $58.78 / $81.93	Professional	TC	$46.71	$58.78	$81.93
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $99.25 / $99.25 / $300.99	Professional		$99.25	$99.25	$300.99
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $34.20 / $34.20 / $64.64	Professional	26	$34.20	$34.20	$64.64
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $65.05 / $65.05 / $122.94	Professional	TC	$65.05	$65.05	$122.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.11 / $35.11 / $35.11	Facility	26	$35.11	$35.11	$35.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.73 / $107.57 / $194.33	Professional		$65.73	$107.57	$194.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.68 / $39.79 / $73.01	Professional	26	$24.68	$39.79	$73.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.70 / $67.14 / $123.28	Professional	TC	$40.70	$67.14	$123.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $76.87 / $94.96 / $116.81	Professional		$76.87	$94.96	$116.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.72 / $35.22 / $43.57	Professional	26	$27.72	$35.22	$43.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.67 / $60.72 / $75.05	Professional	TC	$47.67	$60.72	$75.05
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $45.33 / $55.00 / $90.00	Facility	26	$45.33	$55.00	$90.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $43.00 / $80.00 / $144.00	Professional		$43.00	$80.00	$144.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $41.12 / $102.91 / $197.14	Professional		$41.12	$102.91	$197.14
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $33.02 / $43.54 / $70.18	Professional	26	$33.02	$43.54	$70.18
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $53.44 / $76.55 / $117.49	Professional	TC	$53.44	$76.55	$117.49
United Facility/Professional Professional Modifier Low / Median / High Price $67.00 / $101.82 / $145.58	Professional		$67.00	$101.82	$145.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.77 / $36.52 / $59.76	Professional	26	$23.77	$36.52	$59.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.94 / $58.35 / $96.93	Professional	TC	$40.94	$58.35	$96.93