Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $23.44 / $61.66	Facility	26	$13.80	$23.44	$61.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $54.95 / $169.82	Professional		$39.81	$54.95	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $23.44 / $48.98	Professional	26	$12.88	$23.44	$48.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $38.90 / $75.86	Professional	TC	$28.18	$38.90	$75.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $67.61 / $104.71	Professional		$48.98	$67.61	$104.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $19.95 / $30.20	Professional	26	$14.45	$19.95	$30.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $47.86 / $74.13	Professional	TC	$33.88	$47.86	$74.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $58.88 / $181.97	Professional		$50.12	$58.88	$181.97
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $16.22 / $24.55	Professional	26	$14.79	$16.22	$24.55
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $42.66 / $60.26	Professional	TC	$38.90	$42.66	$60.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.80 / $17.38 / $25.12	Facility	26	$3.80	$17.38	$25.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $64.57 / $109.65	Professional		$40.74	$64.57	$109.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $19.05 / $33.11	Professional	26	$12.02	$19.05	$33.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $42.66 / $77.62	Professional	TC	$28.84	$42.66	$77.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $60.26 / $75.86	Professional		$50.12	$60.26	$75.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $17.38 / $21.88	Professional	26	$13.80	$17.38	$21.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $43.65 / $54.95	Professional	TC	$35.48	$43.65	$54.95
Medcost Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $81.28 / $112.20	Professional		$64.57	$81.28	$112.20
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $27.54 / $33.11	Professional	26	$21.88	$27.54	$33.11
Medcost Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $60.26 / $85.11	Professional		$60.26	$60.26	$85.11
Sentara Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $58.88 / $309.03	Professional		$19.95	$58.88	$309.03
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $20.42 / $33.88	Professional	26	$15.49	$20.42	$33.88
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $46.77 / $81.28	Professional	TC	$34.67	$46.77	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $58.88 / $100.00	Professional		$38.90	$58.88	$100.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $17.78 / $30.90	Professional	26	$12.02	$17.78	$30.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $39.81 / $69.18	Professional	TC	$26.92	$39.81	$69.18