Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $51.29 / $151.36	Facility	26	$26.92	$51.29	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $112.20 / $288.40	Professional		$83.18	$112.20	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $38.02 / $141.25	Professional	26	$22.91	$38.02	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $81.28 / $154.88	Professional	TC	$63.10	$81.28	$154.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $53.70 / $95.50	Professional		$53.70	$53.70	$95.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $14.79 / $25.70	Professional	26	$14.79	$14.79	$25.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $38.90 / $69.18	Professional	TC	$38.90	$38.90	$69.18
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $134.90 / $147.91	Professional		$125.89	$134.90	$147.91
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $31.62 / $35.48	Professional	26	$30.20	$31.62	$35.48
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $102.33 / $112.20	Professional	TC	$95.50	$102.33	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $79.43 / $218.78	Professional		$47.86	$79.43	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $19.05 / $53.70	Professional	26	$13.49	$19.05	$53.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $60.26 / $162.18	Professional	TC	$34.67	$60.26	$162.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $162.18 / $181.97	Professional		$125.89	$162.18	$181.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $38.02 / $43.65	Professional	26	$31.62	$38.02	$43.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $120.23 / $138.04	Professional	TC	$93.33	$120.23	$138.04
Medcost Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $295.12	Professional		$32.36	$32.36	$295.12
Sentara Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $123.03 / $489.78	Professional		$39.81	$123.03	$489.78
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $42.66 / $79.43	Professional	26	$30.20	$42.66	$79.43
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $123.03 / $257.04	Professional	TC	$79.43	$123.03	$257.04
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $114.82 / $218.78	Professional		$70.79	$114.82	$218.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $30.20 / $56.23	Professional	26	$18.20	$30.20	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $85.11 / $162.18	Professional	TC	$53.70	$85.11	$162.18