Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.11 / $56.81 / $93.14	Facility	26	$42.11	$56.81	$93.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.93 / $100.33 / $206.51	Professional		$79.93	$100.33	$206.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.29 / $49.59 / $90.91	Professional	26	$40.29	$49.59	$90.91
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $205.24 / $205.24 / $205.24	Professional	50	$205.24	$205.24	$205.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.04 / $51.12 / $85.15	Professional	TC	$40.04	$51.12	$85.15
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $82.61 / $110.42 / $169.79	Professional		$82.61	$110.42	$169.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.68 / $50.78 / $77.89	Professional	26	$39.68	$50.78	$77.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.03 / $59.85 / $91.96	Professional	TC	$41.03	$59.85	$91.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $88.22 / $98.02 / $191.14	Professional		$88.22	$98.02	$191.14
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $41.56 / $41.56 / $81.04	Professional	26	$41.56	$41.56	$81.04
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $50.82 / $56.46 / $110.10	Professional	TC	$50.82	$56.46	$110.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.99 / $124.10 / $210.44	Professional		$87.99	$124.10	$210.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.30 / $62.94 / $104.12	Professional	26	$42.30	$62.94	$104.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.76 / $64.61 / $118.81	Professional	TC	$44.76	$64.61	$118.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $88.55 / $107.28 / $135.43	Professional		$88.55	$107.28	$135.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.38 / $49.88 / $61.75	Professional	26	$40.38	$49.88	$61.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.06 / $56.68 / $73.68	Professional	TC	$48.06	$56.68	$73.68
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $60.33 / $97.44 / $122.14	Facility	26	$60.33	$97.44	$122.14
Medcost Facility/Professional Professional Modifier Low / Median / High Price $55.00 / $78.20 / $146.54	Professional		$55.00	$78.20	$146.54
Sentara Facility/Professional Professional Modifier Low / Median / High Price $47.04 / $103.83 / $192.24	Professional		$47.04	$103.83	$192.24
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $46.69 / $63.46 / $101.65	Professional	26	$46.69	$63.46	$101.65
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $45.03 / $66.91 / $119.66	Professional	TC	$45.03	$66.91	$119.66
United Facility/Professional Professional Modifier Low / Median / High Price $77.95 / $131.47 / $205.02	Professional		$77.95	$131.47	$205.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.99 / $62.94 / $93.14	Professional	26	$37.99	$62.94	$93.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.39 / $64.13 / $100.27	Professional	TC	$38.39	$64.13	$100.27