Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $66.07 / $194.98	Facility	26	$38.02	$66.07	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $91.20 / $177.83	Professional		$67.61	$91.20	$177.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $48.98 / $128.82	Professional	26	$38.02	$48.98	$128.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $38.90 / $75.86	Professional	TC	$22.91	$38.90	$75.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $104.71 / $165.96	Professional		$75.86	$104.71	$165.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $53.70 / $83.18	Professional	26	$38.90	$53.70	$83.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $51.29 / $81.28	Professional	TC	$36.31	$51.29	$81.28
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $87.10 / $229.09	Professional		$41.69	$87.10	$229.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $42.66 / $57.54	Professional	26	$38.90	$42.66	$57.54
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $46.77 / $60.26	Professional	TC	$43.65	$46.77	$60.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $95.50 / $177.83	Professional		$69.18	$95.50	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $56.23 / $97.72	Professional	26	$40.74	$56.23	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $37.15 / $77.62	Professional	TC	$24.55	$37.15	$77.62
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 $31.62 / $43.65 / $95.50	Professional	26	$31.62	$43.65	$95.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $45.71 / $81.28	Professional	TC	$30.20	$45.71	$81.28
Medcost Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $104.71 / $147.91	Professional		$83.18	$104.71	$147.91
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $70.79 / $77.62	Professional	26	$56.23	$70.79	$77.62
Medcost Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $56.23 / $56.23	Professional		$56.23	$56.23	$56.23
Sentara Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $72.44 / $151.36	Professional		$27.54	$72.44	$151.36
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $53.70 / $93.33	Professional	26	$41.69	$53.70	$93.33
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $38.02 / $79.43	Professional	TC	$20.42	$38.02	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $83.18 / $138.04	Professional		$58.88	$83.18	$138.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $50.12 / $83.18	Professional	26	$35.48	$50.12	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $33.11 / $58.88	Professional	TC	$21.38	$33.11	$58.88