Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $19.50 / $51.29	Facility	26	$11.22	$19.50	$51.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $43.65 / $120.23	Professional		$17.78	$43.65	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.05 / $43.65	Professional	26	$10.96	$19.05	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $32.36 / $66.07	Professional	TC	$21.88	$32.36	$66.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $53.70 / $87.10	Professional		$38.90	$53.70	$87.10
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $16.22 / $25.12	Professional	26	$11.75	$16.22	$25.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $37.15 / $58.88	Professional	TC	$26.92	$37.15	$58.88
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $13.49 / $47.86 / $123.03	Professional		$13.49	$47.86	$123.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $12.02 / $16.98	Professional	26	$12.02	$12.02	$16.98
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $33.88 / $47.86	Professional	TC	$28.84	$33.88	$47.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.09 / $14.45 / $20.89	Facility	26	$3.09	$14.45	$20.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $50.12 / $87.10	Professional		$32.36	$50.12	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $16.22 / $28.18	Professional	26	$10.00	$16.22	$28.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $32.36 / $61.66	Professional	TC	$21.88	$32.36	$61.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $48.98 / $61.66	Professional		$40.74	$48.98	$61.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $14.45 / $18.62	Professional	26	$11.75	$14.45	$18.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $35.48 / $43.65	Professional	TC	$28.84	$35.48	$43.65
Medcost Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $63.10 / $91.20	Professional		$51.29	$63.10	$91.20
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $23.44 / $27.54	Professional	26	$19.05	$23.44	$27.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $69.18	Professional		$50.12	$50.12	$69.18
Sentara Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $44.67 / $275.42	Professional		$16.60	$44.67	$275.42
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.98 / $28.84	Professional	26	$13.18	$16.98	$28.84
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $36.31 / $64.57	Professional	TC	$27.54	$36.31	$64.57
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $45.71 / $77.62	Professional		$30.20	$45.71	$77.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.14 / $25.70	Professional	26	$10.00	$15.14	$25.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $30.20 / $52.48	Professional	TC	$19.95	$30.20	$52.48