Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.67 / $65.79 / $195.01	Facility	26	$47.67	$65.79	$195.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.72 / $79.83 / $133.94	Professional		$63.72	$79.83	$133.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.65 / $47.02 / $75.84	Professional	26	$37.65	$47.02	$75.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.30 / $37.25 / $49.67	Professional	TC	$20.30	$37.25	$49.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $71.25 / $93.14 / $139.72	Professional		$71.25	$93.14	$139.72
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.86 / $47.16 / $70.73	Professional	26	$36.86	$47.16	$70.73
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.17 / $45.98 / $68.97	Professional	TC	$35.17	$45.98	$68.97
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $93.83 / $93.83 / $240.08	Professional		$93.83	$93.83	$240.08
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.07 / $52.07 / $98.41	Professional	26	$52.07	$52.07	$98.41
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $41.76 / $41.76 / $78.93	Professional	TC	$41.76	$41.76	$78.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.78 / $92.95 / $183.13	Professional		$69.78	$92.95	$183.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.76 / $55.51 / $105.60	Professional	26	$39.76	$55.51	$105.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.59 / $36.69 / $78.48	Professional	TC	$24.59	$36.69	$78.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $69.50 / $86.87 / $129.69	Professional		$69.50	$86.87	$129.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.34 / $42.92 / $72.81	Professional	26	$34.34	$42.92	$72.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.15 / $43.95 / $59.33	Professional	TC	$35.15	$43.95	$59.33
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $47.98 / $54.83 / $109.42	Facility	26	$47.98	$54.83	$109.42
Medcost Facility/Professional Professional Modifier Low / Median / High Price $27.00 / $69.77 / $115.00	Professional		$27.00	$69.77	$115.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $27.69 / $72.42 / $138.55	Professional		$27.69	$72.42	$138.55
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $42.14 / $52.88 / $88.20	Professional	26	$42.14	$52.88	$88.20
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $20.56 / $37.63 / $71.39	Professional	TC	$20.56	$37.63	$71.39
United Facility/Professional Professional Modifier Low / Median / High Price $59.45 / $86.74 / $142.88	Professional		$59.45	$86.74	$142.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.04 / $51.45 / $80.72	Professional	26	$35.04	$51.45	$80.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.27 / $33.32 / $56.56	Professional	TC	$21.27	$33.32	$56.56