Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $45.71 / $169.82	Facility	26	$33.11	$45.71	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $77.62 / $151.36	Professional		$61.66	$77.62	$151.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $43.65 / $107.15	Professional	26	$33.11	$43.65	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $36.31 / $58.88	Professional	TC	$20.89	$36.31	$58.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $95.50 / $151.36	Professional		$67.61	$95.50	$151.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $47.86 / $74.13	Professional	26	$34.67	$47.86	$74.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $47.86 / $75.86	Professional	TC	$33.88	$47.86	$75.86
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $70.79 / $181.97	Professional		$37.15	$70.79	$181.97
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $41.69 / $51.29	Professional	26	$33.88	$41.69	$51.29
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $50.12 / $61.66	Professional	TC	$38.90	$50.12	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $89.13 / $165.96	Professional		$67.61	$89.13	$165.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $52.48 / $87.10	Professional	26	$35.48	$52.48	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $34.67 / $72.44	Professional	TC	$22.91	$34.67	$72.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $81.28 / $173.78	Professional		$56.23	$81.28	$173.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $38.90 / $83.18	Professional	26	$28.18	$38.90	$83.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $41.69 / $77.62	Professional	TC	$28.18	$41.69	$77.62
Medcost Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $95.50 / $134.90	Professional		$77.62	$95.50	$134.90
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $67.61	Professional	26	$52.48	$66.07	$67.61
Medcost Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $54.95 / $54.95	Professional		$54.95	$54.95	$54.95
Sentara Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $69.18 / $138.04	Professional		$25.70	$69.18	$138.04
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $50.12 / $81.28	Professional	26	$37.15	$50.12	$81.28
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $34.67 / $72.44	Professional	TC	$19.95	$34.67	$72.44
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $77.62 / $125.89	Professional		$53.70	$77.62	$125.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $45.71 / $74.13	Professional	26	$31.62	$45.71	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $30.90 / $54.95	Professional	TC	$19.95	$30.90	$54.95