Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $57.54 / $93.33	Facility	26	$33.88	$57.54	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $85.11 / $181.97	Professional		$64.57	$85.11	$181.97
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	25	$93.33	$93.33	$93.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $41.69 / $109.65	Professional	26	$33.11	$41.69	$109.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $41.69 / $77.62	Professional	TC	$21.88	$41.69	$77.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $104.71 / $162.18	Professional		$74.13	$104.71	$162.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $47.86 / $75.86	Professional	26	$34.67	$47.86	$75.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $56.23 / $89.13	Professional	TC	$39.81	$56.23	$89.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $77.62 / $190.55	Professional		$38.02	$77.62	$190.55
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $42.66 / $56.23	Professional	26	$34.67	$42.66	$56.23
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $51.29 / $66.07	Professional	TC	$42.66	$51.29	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $89.13 / $173.78	Professional		$64.57	$89.13	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $51.29 / $89.13	Professional	26	$36.31	$51.29	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $39.81 / $83.18	Professional	TC	$23.44	$39.81	$83.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $89.13 / $190.55	Professional		$61.66	$89.13	$190.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $39.81 / $87.10	Professional	26	$28.84	$39.81	$87.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $48.98 / $85.11	Professional	TC	$33.11	$48.98	$85.11
Medcost Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $95.50 / $147.91	Professional		$75.86	$95.50	$147.91
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $64.57 / $69.18	Professional	26	$51.29	$64.57	$69.18
Medcost Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $52.48 / $52.48	Professional		$52.48	$52.48	$52.48
Sentara Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $67.61 / $186.21	Professional		$26.30	$67.61	$186.21
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $48.98 / $83.18	Professional	26	$38.02	$48.98	$83.18
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $40.74 / $85.11	Professional	TC	$20.42	$40.74	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $79.43 / $134.90	Professional		$56.23	$79.43	$134.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $45.71 / $75.86	Professional	26	$33.11	$45.71	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $33.88 / $63.10	Professional	TC	$20.42	$33.88	$63.10