Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.65 / $50.40 / $93.91	Facility	26	$29.65	$50.40	$93.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.38 / $126.18 / $231.92	Professional		$106.38	$126.18	$231.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.64 / $32.76 / $69.45	Professional	26	$29.64	$32.76	$69.45
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $49.15 / $54.49 / $68.50	Professional	52	$49.15	$54.49	$68.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.04 / $86.23 / $156.81	Professional	TC	$76.04	$86.23	$156.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.62 / $135.13 / $192.95	Professional		$107.62	$135.13	$192.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.80 / $36.97 / $52.50	Professional	26	$29.80	$36.97	$52.50
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.45 / $97.91 / $140.66	Professional	TC	$78.45	$97.91	$140.66
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $139.80 / $139.80 / $320.63	Professional		$139.80	$139.80	$320.63
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $36.39 / $36.39 / $68.78	Professional	26	$36.39	$36.39	$68.78
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $103.41 / $103.41 / $195.44	Professional	TC	$103.41	$103.41	$195.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.29 / $137.87 / $279.22	Professional		$92.29	$137.87	$279.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.32 / $43.09 / $77.78	Professional	26	$26.32	$43.09	$77.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.03 / $96.25 / $202.55	Professional	TC	$63.03	$96.25	$202.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.39 / $139.69 / $173.82	Professional		$112.39	$139.69	$173.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.54 / $37.53 / $46.43	Professional	26	$29.54	$37.53	$46.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.02 / $103.22 / $129.35	Professional	TC	$81.02	$103.22	$129.35
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $49.01 / $67.00 / $109.87	Facility	26	$49.01	$67.00	$109.87
Medcost Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $117.00 / $204.82	Professional		$45.00	$117.00	$204.82
Sentara Facility/Professional Professional Modifier Low / Median / High Price $45.07 / $140.66 / $285.77	Professional		$45.07	$140.66	$285.77
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $35.04 / $46.33 / $73.98	Professional	26	$35.04	$46.33	$73.98
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $87.85 / $126.10 / $200.80	Professional	TC	$87.85	$126.10	$200.80
United Facility/Professional Professional Modifier Low / Median / High Price $84.17 / $130.05 / $225.38	Professional		$84.17	$130.05	$225.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.71 / $38.67 / $56.59	Professional	26	$25.71	$38.67	$56.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.86 / $87.79 / $157.68	Professional	TC	$57.86	$87.79	$157.68