Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $31.62 / $181.97	Facility	26	$15.85	$31.62	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $70.79 / $275.42	Professional		$53.70	$70.79	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $21.88 / $93.33	Professional	26	$15.85	$21.88	$93.33
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $223.87 / $263.03	Professional	50	$28.84	$223.87	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $43.65 / $74.13	Professional	TC	$36.31	$43.65	$74.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $81.28 / $144.54	Professional		$57.54	$81.28	$144.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $23.99 / $42.66	Professional	26	$16.98	$23.99	$42.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $57.54 / $102.33	Professional	TC	$39.81	$57.54	$102.33
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $48.98 / $75.86	Professional		$16.60	$48.98	$75.86
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $19.05 / $23.99	Professional	26	$17.38	$19.05	$23.99
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $53.70 / $67.61	Professional	TC	$45.71	$53.70	$67.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.37 / $20.42 / $29.51	Facility	26	$4.37	$20.42	$29.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $79.43 / $131.83	Professional		$57.54	$79.43	$131.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $24.55 / $38.02	Professional	26	$17.38	$24.55	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $56.23 / $95.50	Professional	TC	$39.81	$56.23	$95.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $74.13 / $93.33	Professional		$60.26	$74.13	$93.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $20.42 / $26.30	Professional	26	$16.22	$20.42	$26.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $53.70 / $67.61	Professional	TC	$43.65	$53.70	$67.61
Medcost Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Professional		$125.89	$125.89	$125.89
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $33.88 / $33.88	Professional	26	$33.88	$33.88	$33.88
Medcost Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $33.11 / $33.11	Professional		$33.11	$33.11	$33.11
Sentara Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $63.10 / $128.82	Professional		$21.88	$63.10	$128.82
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $23.99 / $38.90	Professional	26	$17.38	$23.99	$38.90
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $54.95 / $95.50	Professional	TC	$40.74	$54.95	$95.50
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $81.28 / $125.89	Professional		$50.12	$81.28	$125.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $23.99 / $38.90	Professional	26	$15.14	$23.99	$38.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $56.23 / $87.10	Professional	TC	$35.48	$56.23	$87.10