Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.78 / $23.42 / $44.52	Facility	26	$13.78	$23.42	$44.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.13 / $47.68 / $84.75	Professional		$40.13	$47.68	$84.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.65 / $14.96 / $27.37	Professional	26	$12.65	$14.96	$27.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.75 / $34.09 / $58.31	Professional	TC	$28.75	$34.09	$58.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.47 / $59.11 / $90.00	Professional		$47.47	$59.11	$90.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.73 / $17.60 / $26.54	Professional	26	$13.73	$17.60	$26.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.95 / $41.81 / $61.12	Professional	TC	$31.95	$41.81	$61.12
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $58.12 / $58.12 / $155.49	Professional		$58.12	$58.12	$155.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $17.11 / $21.73	Professional	26	$17.05	$17.11	$21.73
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $39.04 / $41.01 / $52.08	Professional	TC	$39.04	$41.01	$52.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.71 / $17.71 / $17.71	Facility	26	$17.71	$17.71	$17.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.62 / $64.56 / $110.30	Professional		$41.62	$64.56	$110.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.40 / $20.39 / $34.52	Professional	26	$12.40	$20.39	$34.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.48 / $44.58 / $77.06	Professional	TC	$29.48	$44.58	$77.06
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.24 / $60.29 / $73.91	Professional		$50.24	$60.29	$73.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.87 / $17.14 / $20.66	Professional	26	$13.87	$17.14	$20.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.36 / $43.65 / $53.49	Professional	TC	$36.36	$43.65	$53.49
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $22.68 / $27.00 / $47.76	Facility	26	$22.68	$27.00	$47.76
Medcost Facility/Professional Professional Modifier Low / Median / High Price $21.00 / $52.00 / $87.86	Professional		$21.00	$52.00	$87.86
Sentara Facility/Professional Professional Modifier Low / Median / High Price $21.72 / $63.61 / $116.85	Professional		$21.72	$63.61	$116.85
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $15.91 / $21.99 / $34.04	Professional	26	$15.91	$21.99	$34.04
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $37.47 / $51.49 / $81.36	Professional	TC	$37.47	$51.49	$81.36
United Facility/Professional Professional Modifier Low / Median / High Price $39.72 / $61.57 / $94.31	Professional		$39.72	$61.57	$94.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.39 / $19.39 / $32.00	Professional	26	$12.39	$19.39	$32.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.01 / $42.02 / $65.30	Professional	TC	$28.01	$42.02	$65.30