Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.97 / $46.11 / $170.80	Facility	26	$33.97	$46.11	$170.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.76 / $71.98 / $120.91	Professional		$61.76	$71.98	$120.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $41.76 / $66.58	Professional	26	$33.97	$41.76	$66.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.75 / $34.50 / $46.97	Professional	TC	$18.75	$34.50	$46.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.64 / $84.50 / $126.75	Professional		$64.64	$84.50	$126.75
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.57 / $41.66 / $62.49	Professional	26	$32.57	$41.66	$62.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.77 / $42.84 / $64.25	Professional	TC	$32.77	$42.84	$64.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $80.23 / $80.23 / $202.55	Professional		$80.23	$80.23	$202.55
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $41.55 / $41.55 / $78.53	Professional	26	$41.55	$41.55	$78.53
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 $67.00 / $87.67 / $168.20	Professional		$67.00	$87.67	$168.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.61 / $52.41 / $93.09	Professional	26	$35.61	$52.41	$93.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.25 / $34.49 / $72.95	Professional	TC	$23.25	$34.49	$72.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $62.74 / $78.43 / $116.75	Professional		$62.74	$78.43	$116.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.06 / $37.57 / $63.84	Professional	26	$30.06	$37.57	$63.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.69 / $40.86 / $55.16	Professional	TC	$32.69	$40.86	$55.16
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $49.98 / $50.31 / $95.93	Facility	26	$49.98	$50.31	$95.93
Medcost Facility/Professional Professional Modifier Low / Median / High Price $26.00 / $64.00 / $111.00	Professional		$26.00	$64.00	$111.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $26.14 / $69.37 / $129.60	Professional		$26.14	$69.37	$129.60
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $37.50 / $51.50 / $81.06	Professional	26	$37.50	$51.50	$81.06
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $19.87 / $35.04 / $66.42	Professional	TC	$19.87	$35.04	$66.42
United Facility/Professional Professional Modifier Low / Median / High Price $53.60 / $80.58 / $128.40	Professional		$53.60	$80.58	$128.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.34 / $45.80 / $74.80	Professional	26	$31.34	$45.80	$74.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.18 / $31.44 / $54.74	Professional	TC	$20.18	$31.44	$54.74