Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.88 / $39.34 / $148.30	Facility	26	$28.88	$39.34	$148.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.29 / $67.23 / $102.91	Professional		$50.29	$67.23	$102.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.08 / $35.52 / $56.39	Professional	26	$28.08	$35.52	$56.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.03 / $34.01 / $46.34	Professional	TC	$18.03	$34.01	$46.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.42 / $78.98 / $118.50	Professional		$60.42	$78.98	$118.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.96 / $35.76 / $53.65	Professional	26	$27.96	$35.76	$53.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.07 / $43.23 / $64.84	Professional	TC	$33.07	$43.23	$64.84
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $77.51 / $77.51 / $181.91	Professional		$77.51	$77.51	$181.91
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.83 / $38.83 / $73.39	Professional	26	$38.83	$38.83	$73.39
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $38.68 / $38.68 / $73.11	Professional	TC	$38.68	$38.68	$73.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.72 / $74.77 / $151.41	Professional		$56.72	$74.77	$151.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.22 / $42.57 / $79.66	Professional	26	$30.22	$42.57	$79.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.67 / $33.25 / $73.65	Professional	TC	$20.67	$33.25	$73.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $59.10 / $73.87 / $107.73	Professional		$59.10	$73.87	$107.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.10 / $32.61 / $54.83	Professional	26	$26.10	$32.61	$54.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.31 / $41.25 / $55.69	Professional	TC	$30.31	$41.25	$55.69
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $36.65 / $41.89 / $82.62	Facility	26	$36.65	$41.89	$82.62
Medcost Facility/Professional Professional Modifier Low / Median / High Price $24.00 / $54.20 / $94.00	Professional		$24.00	$54.20	$94.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $22.84 / $57.52 / $114.57	Professional		$22.84	$57.52	$114.57
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $31.99 / $40.40 / $66.41	Professional	26	$31.99	$40.40	$66.41
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $17.61 / $33.99 / $66.42	Professional	TC	$17.61	$33.99	$66.42
United Facility/Professional Professional Modifier Low / Median / High Price $46.46 / $70.05 / $116.89	Professional		$46.46	$70.05	$116.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.44 / $38.38 / $61.01	Professional	26	$26.44	$38.38	$61.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.57 / $29.75 / $54.74	Professional	TC	$18.57	$29.75	$54.74