Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $33.88 / $114.82	Facility	26	$25.70	$33.88	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $63.10 / $147.91	Professional		$44.67	$63.10	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $43.65 / $95.50	Professional	26	$25.70	$43.65	$95.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.79 / $45.71 / $229.09	Professional	52	$14.79	$45.71	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $27.54 / $81.28	Professional	TC	$19.05	$27.54	$81.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $69.18 / $102.33	Professional		$50.12	$69.18	$102.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $36.31 / $54.95	Professional	26	$26.92	$36.31	$54.95
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $31.62 / $46.77	Professional	TC	$22.91	$31.62	$46.77
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $52.48 / $75.86	Professional		$26.92	$52.48	$75.86
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $30.20 / $38.02	Professional	26	$30.20	$30.20	$38.02
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $27.54 / $38.90	Professional	TC	$25.12	$27.54	$38.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.92 / $32.36 / $46.77	Facility	26	$6.92	$32.36	$46.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $67.61 / $112.20	Professional		$41.69	$67.61	$112.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $36.31 / $61.66	Professional	26	$22.39	$36.31	$61.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $30.90 / $51.29	Professional	TC	$19.05	$30.90	$51.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $60.26 / $74.13	Professional		$48.98	$60.26	$74.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $31.62 / $40.74	Professional	26	$25.70	$31.62	$40.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $28.18 / $35.48	Professional	TC	$23.44	$28.18	$35.48
Medcost Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $114.82 / $114.82	Professional		$114.82	$114.82	$114.82
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $61.66 / $61.66	Professional	26	$61.66	$61.66	$61.66
Medcost Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $38.02 / $85.11	Professional		$38.02	$38.02	$85.11
Sentara Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $54.95 / $120.23	Professional		$27.54	$54.95	$120.23
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $38.02 / $64.57	Professional	26	$29.51	$38.02	$64.57
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $31.62 / $54.95	Professional	TC	$25.12	$31.62	$54.95
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $66.07 / $104.71	Professional		$41.69	$66.07	$104.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $35.48 / $56.23	Professional	26	$21.88	$35.48	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $30.20 / $48.98	Professional	TC	$19.50	$30.20	$48.98