Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.74 / $49.37 / $118.34	Facility	26	$27.74	$49.37	$118.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $99.30 / $113.19 / $232.61	Professional		$99.30	$113.19	$232.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.42 / $29.92 / $67.77	Professional	26	$23.42	$29.92	$67.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.86 / $82.43 / $169.42	Professional	TC	$62.86	$82.43	$169.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.00 / $54.00 / $82.31	Professional		$54.00	$54.00	$82.31
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.69 / $14.69 / $22.37	Professional	26	$14.69	$14.69	$22.37
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.31 / $39.31 / $59.88	Professional	TC	$39.31	$39.31	$59.88
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $136.13 / $136.13 / $265.47	Professional		$136.13	$136.13	$265.47
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $37.96 / $37.96 / $74.02	Professional	26	$37.96	$37.96	$74.02
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $98.18 / $98.18 / $191.45	Professional	TC	$98.18	$98.18	$191.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $81.84 / $227.57	Professional		$47.86	$81.84	$227.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $18.98 / $58.75	Professional	26	$13.49	$18.98	$58.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.36 / $63.36 / $172.28	Professional	TC	$34.36	$63.36	$172.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.44 / $172.82 / $182.69	Professional		$123.44	$172.82	$182.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.53 / $41.32 / $46.66	Professional	26	$31.53	$41.32	$46.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $91.91 / $128.66 / $139.28	Professional	TC	$91.91	$128.66	$139.28
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $49.10 / $98.05	Facility	26	$39.81	$49.10	$98.05
Medcost Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $124.00 / $259.95	Professional		$45.00	$124.00	$259.95
Sentara Facility/Professional Professional Modifier Low / Median / High Price $39.40 / $120.12 / $328.62	Professional		$39.40	$120.12	$328.62
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $26.98 / $40.34 / $83.57	Professional	26	$26.98	$40.34	$83.57
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $79.17 / $117.87 / $254.63	Professional	TC	$79.17	$117.87	$254.63
United Facility/Professional Professional Modifier Low / Median / High Price $70.19 / $117.00 / $210.59	Professional		$70.19	$117.00	$210.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.03 / $30.21 / $54.14	Professional	26	$18.03	$30.21	$54.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.50 / $89.14 / $159.55	Professional	TC	$53.50	$89.14	$159.55