Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $20.89 / $56.23	Facility	26	$12.30	$20.89	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $47.86 / $102.33	Professional		$33.11	$47.86	$102.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $18.20 / $43.65	Professional	26	$10.96	$18.20	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $30.20 / $60.26	Professional	TC	$21.88	$30.20	$60.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $56.23 / $87.10	Professional		$40.74	$56.23	$87.10
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $17.78 / $26.92	Professional	26	$12.88	$17.78	$26.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $38.90 / $60.26	Professional	TC	$27.54	$38.90	$60.26
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $44.67 / $138.04	Professional		$14.45	$44.67	$138.04
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $13.18 / $20.42	Professional	26	$12.88	$13.18	$20.42
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $30.90 / $52.48	Professional	TC	$30.90	$30.90	$52.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.39 / $15.85 / $22.39	Facility	26	$3.39	$15.85	$22.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $52.48 / $91.20	Professional		$33.88	$52.48	$91.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $16.98 / $28.84	Professional	26	$10.72	$16.98	$28.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $34.67 / $63.10	Professional	TC	$22.91	$34.67	$63.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $51.29 / $63.10	Professional		$41.69	$51.29	$63.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $15.14 / $19.50	Professional	26	$12.30	$15.14	$19.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $35.48 / $44.67	Professional	TC	$28.84	$35.48	$44.67
Medcost Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $70.79 / $95.50	Professional		$56.23	$70.79	$95.50
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $23.44 / $30.20	Professional	26	$19.05	$23.44	$30.20
Medcost Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $70.79	Professional		$50.12	$50.12	$70.79
Sentara Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $47.86 / $288.40	Professional		$17.78	$47.86	$288.40
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $17.78 / $30.90	Professional	26	$13.80	$17.78	$30.90
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $37.15 / $66.07	Professional	TC	$28.84	$37.15	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $47.86 / $85.11	Professional		$32.36	$47.86	$85.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $15.49 / $27.54	Professional	26	$10.47	$15.49	$27.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $31.62 / $56.23	Professional	TC	$21.88	$31.62	$56.23