Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.24 / $48.49 / $111.35	Facility	26	$41.24	$48.49	$111.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.68 / $86.84 / $120.57	Professional		$68.68	$86.84	$120.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.85 / $43.79 / $58.71	Professional	26	$36.85	$43.79	$58.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.82 / $41.17 / $59.08	Professional	TC	$34.82	$41.17	$59.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.18 / $98.40 / $155.05	Professional		$70.18	$98.40	$155.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.65 / $50.20 / $76.70	Professional	26	$36.65	$50.20	$76.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.41 / $49.76 / $78.41	Professional	TC	$31.41	$49.76	$78.41
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $79.45 / $85.88 / $167.47	Professional		$79.45	$85.88	$167.47
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $39.35 / $40.35 / $78.68	Professional	26	$39.35	$40.35	$78.68
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $40.98 / $45.53 / $88.78	Professional	TC	$40.98	$45.53	$88.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.38 / $109.72 / $192.53	Professional		$72.38	$109.72	$192.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.93 / $60.53 / $102.86	Professional	26	$41.93	$60.53	$102.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.85 / $52.22 / $97.67	Professional	TC	$21.85	$52.22	$97.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.52 / $99.19 / $124.67	Professional		$81.52	$99.19	$124.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.24 / $48.48 / $60.02	Professional	26	$39.24	$48.48	$60.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.24 / $49.73 / $64.65	Professional	TC	$42.24	$49.73	$64.65
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $42.16 / $58.00 / $115.72	Facility	26	$42.16	$58.00	$115.72
Medcost Facility/Professional Professional Modifier Low / Median / High Price $48.00 / $73.00 / $125.00	Professional		$48.00	$73.00	$125.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $42.07 / $90.61 / $173.71	Professional		$42.07	$90.61	$173.71
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $45.25 / $62.51 / $99.33	Professional	26	$45.25	$62.51	$99.33
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $40.99 / $59.90 / $94.65	Professional	TC	$40.99	$59.90	$94.65
United Facility/Professional Professional Modifier Low / Median / High Price $60.76 / $102.61 / $175.00	Professional		$60.76	$102.61	$175.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.07 / $59.41 / $91.27	Professional	26	$37.07	$59.41	$91.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.18 / $48.88 / $88.78	Professional	TC	$22.18	$48.88	$88.78