Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.34 / $19.18 / $48.93	Facility	26	$11.34	$19.18	$48.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.86 / $92.44 / $178.81	Professional		$77.86	$92.44	$178.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.34 / $13.48 / $22.83	Professional	26	$11.34	$13.48	$22.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $37.93 / $41.96 / $50.35	Professional	52	$37.93	$41.96	$50.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.08 / $77.93 / $159.38	Professional	TC	$67.08	$77.93	$159.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.90 / $97.07 / $133.97	Professional		$75.90	$97.07	$133.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.76 / $13.66 / $19.10	Professional	26	$10.76	$13.66	$19.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.15 / $83.32 / $114.98	Professional	TC	$65.15	$83.32	$114.98
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $105.93 / $105.93 / $386.09	Professional		$105.93	$105.93	$386.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.23 / $12.23 / $23.11	Professional	26	$12.23	$12.23	$23.11
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $93.71 / $93.71 / $177.11	Professional	TC	$93.71	$93.71	$177.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.54 / $13.54 / $13.54	Facility	26	$13.54	$13.54	$13.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.68 / $118.44 / $189.71	Professional		$78.68	$118.44	$189.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.44 / $15.94 / $28.52	Professional	26	$11.44	$15.94	$28.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.34 / $102.83 / $168.21	Professional	TC	$68.34	$102.83	$168.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $77.76 / $98.00 / $119.88	Professional		$77.76	$98.00	$119.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.52 / $13.27 / $16.37	Professional	26	$10.52	$13.27	$16.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.69 / $85.00 / $103.68	Professional	TC	$66.69	$85.00	$103.68
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $12.84 / $22.00 / $36.42	Facility	26	$12.84	$22.00	$36.42
Medcost Facility/Professional Professional Modifier Low / Median / High Price $16.00 / $109.00 / $183.60	Professional		$16.00	$109.00	$183.60
Sentara Facility/Professional Professional Modifier Low / Median / High Price $16.32 / $111.87 / $189.14	Professional		$16.32	$111.87	$189.14
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $11.84 / $16.79 / $27.16	Professional	26	$11.84	$16.79	$27.16
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $80.20 / $107.22 / $166.11	Professional	TC	$80.20	$107.22	$166.11
United Facility/Professional Professional Modifier Low / Median / High Price $70.00 / $113.24 / $186.96	Professional		$70.00	$113.24	$186.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.09 / $15.20 / $25.21	Professional	26	$10.09	$15.20	$25.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.20 / $100.73 / $160.69	Professional	TC	$61.20	$100.73	$160.69