Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.68 / $20.79 / $42.66	Facility	26	$11.68	$20.79	$42.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.51 / $51.50 / $92.43	Professional		$43.51	$51.50	$92.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.67 / $14.50 / $30.01	Professional	26	$11.67	$14.50	$30.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.64 / $38.60 / $70.40	Professional	TC	$30.64	$38.60	$70.40
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.18 / $60.23 / $94.99	Professional		$47.18	$60.23	$94.99
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.42 / $14.93 / $22.36	Professional	26	$11.42	$14.93	$22.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.56 / $46.00 / $72.56	Professional	TC	$33.56	$46.00	$72.56
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $58.13 / $62.02 / $154.46	Professional		$58.13	$62.02	$154.46
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $16.63 / $17.12 / $21.74	Professional	26	$16.63	$17.12	$21.74
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $40.84 / $41.01 / $52.08	Professional	TC	$40.84	$41.01	$52.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.41 / $63.34 / $110.17	Professional		$41.41	$63.34	$110.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.39 / $18.44 / $32.36	Professional	26	$10.39	$18.44	$32.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.78 / $44.25 / $81.38	Professional	TC	$30.78	$44.25	$81.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $52.08 / $62.50 / $76.59	Professional		$52.08	$62.50	$76.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $14.54 / $17.52	Professional	26	$11.77	$14.54	$17.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.31 / $48.37 / $59.28	Professional	TC	$40.31	$48.37	$59.28
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $22.23 / $31.00 / $44.89	Facility	26	$22.23	$31.00	$44.89
Medcost Facility/Professional Professional Modifier Low / Median / High Price $20.00 / $48.83 / $91.00	Professional		$20.00	$48.83	$91.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $20.45 / $61.71 / $116.24	Professional		$20.45	$61.71	$116.24
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $14.77 / $19.98 / $29.99	Professional	26	$14.77	$19.98	$29.99
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $38.77 / $52.44 / $84.17	Professional	TC	$38.77	$52.44	$84.17
United Facility/Professional Professional Modifier Low / Median / High Price $40.65 / $60.97 / $102.16	Professional		$40.65	$60.97	$102.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.80 / $16.80 / $28.23	Professional	26	$10.80	$16.80	$28.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.37 / $44.17 / $73.73	Professional	TC	$28.37	$44.17	$73.73