Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $77.62 / $177.83	Facility	26	$40.74	$77.62	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $63.10 / $109.65	Professional		$52.48	$63.10	$109.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $44.67 / $213.80	Professional	26	$38.02	$44.67	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $19.05 / $34.67	Professional	TC	$15.14	$19.05	$34.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $91.20 / $138.04	Professional		$63.10	$91.20	$138.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $64.57 / $97.72	Professional	26	$44.67	$64.57	$97.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $26.92 / $40.74	Professional	TC	$18.62	$26.92	$40.74
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $69.18 / $223.87	Professional		$30.90	$69.18	$223.87
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $61.66 / $75.86	Professional	26	$42.66	$61.66	$75.86
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $22.39 / $33.88	Professional	TC	$19.95	$22.39	$33.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $85.11 / $144.54	Professional		$54.95	$85.11	$144.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $60.26 / $102.33	Professional	26	$38.90	$60.26	$102.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $25.12 / $46.77	Professional	TC	$16.98	$25.12	$46.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $87.10 / $91.20	Professional		$64.57	$87.10	$91.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $60.26 / $67.61	Professional	26	$45.71	$60.26	$67.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $25.70 / $28.18	Professional	TC	$19.50	$25.70	$28.18
Medcost Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $95.50 / $120.23	Professional		$83.18	$95.50	$120.23
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $67.61 / $87.10	Professional	26	$61.66	$67.61	$87.10
Medcost Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $102.33 / $102.33	Professional		$102.33	$102.33	$102.33
Sentara Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $70.79 / $213.80	Professional		$23.44	$70.79	$213.80
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $60.26 / $109.65	Professional	26	$44.67	$60.26	$109.65
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $25.70 / $43.65	Professional	TC	$18.62	$25.70	$43.65
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $79.43 / $128.82	Professional		$52.48	$79.43	$128.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $56.23 / $87.10	Professional	26	$35.48	$56.23	$87.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $22.91 / $38.90	Professional	TC	$14.79	$22.91	$38.90