Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $21.88 / $53.70	Facility	26	$12.02	$21.88	$53.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $48.98 / $120.23	Professional		$37.15	$48.98	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.14 / $33.88	Professional	26	$10.96	$15.14	$33.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.88 / $66.07	Professional	TC	$23.99	$33.88	$66.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $61.66 / $95.50	Professional		$43.65	$61.66	$95.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $17.38 / $26.30	Professional	26	$12.88	$17.38	$26.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $43.65 / $67.61	Professional	TC	$30.90	$43.65	$67.61
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $53.70 / $151.36	Professional		$20.89	$53.70	$151.36
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $14.13 / $21.38	Professional	26	$12.88	$14.13	$21.38
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $39.81 / $54.95	Professional	TC	$33.88	$39.81	$54.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.24 / $15.14 / $21.88	Facility	26	$3.24	$15.14	$21.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $56.23 / $97.72	Professional		$37.15	$56.23	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $16.60 / $29.51	Professional	26	$10.47	$16.60	$29.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $38.02 / $72.44	Professional	TC	$26.30	$38.02	$72.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $54.95 / $69.18	Professional		$45.71	$54.95	$69.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $14.79 / $19.05	Professional	26	$12.02	$14.79	$19.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $40.74 / $51.29	Professional	TC	$33.11	$40.74	$51.29
Medcost Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $70.79 / $104.71	Professional		$57.54	$70.79	$104.71
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $23.99 / $29.51	Professional	26	$19.50	$23.99	$29.51
Medcost Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $79.43	Professional		$64.57	$64.57	$79.43
Sentara Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $50.12 / $120.23	Professional		$17.38	$50.12	$120.23
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $18.20 / $30.20	Professional	26	$13.80	$18.20	$30.20
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $40.74 / $75.86	Professional	TC	$32.36	$40.74	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $52.48 / $89.13	Professional		$33.88	$52.48	$89.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $15.85 / $27.54	Professional	26	$10.47	$15.85	$27.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $35.48 / $61.66	Professional	TC	$23.44	$35.48	$61.66