Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $14.64 / $53.10	Facility	26	$13.49	$14.64	$53.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.81 / $62.60 / $121.27	Professional		$53.81	$62.60	$121.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.61 / $14.64 / $31.06	Professional	26	$12.61	$14.64	$31.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $48.13 / $95.92	Professional	TC	$42.39	$48.13	$95.92
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.27 / $80.72 / $120.01	Professional		$59.27	$80.72	$120.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.53 / $17.38 / $26.53	Professional	26	$13.53	$17.38	$26.53
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.10 / $63.51 / $94.42	Professional	TC	$47.10	$63.51	$94.42
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $68.75 / $79.34 / $190.85	Professional		$68.75	$79.34	$190.85
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $18.10 / $18.20 / $23.11	Professional	26	$18.10	$18.20	$23.11
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $50.55 / $56.48 / $70.59	Professional	TC	$50.55	$56.48	$70.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.11 / $81.33 / $144.52	Professional		$54.11	$81.33	$144.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.12 / $20.01 / $33.70	Professional	26	$12.12	$20.01	$33.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.05 / $59.88 / $113.56	Professional	TC	$42.05	$59.88	$113.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.98 / $81.58 / $99.98	Professional		$67.98	$81.58	$99.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.58 / $16.78 / $20.10	Professional	26	$13.58	$16.78	$20.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.40 / $65.28 / $80.00	Professional	TC	$54.40	$65.28	$80.00
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $23.97 / $23.97 / $47.50	Facility	26	$23.97	$23.97	$47.50
Medcost Facility/Professional Professional Modifier Low / Median / High Price $20.00 / $65.00 / $123.78	Professional		$20.00	$65.00	$123.78
Sentara Facility/Professional Professional Modifier Low / Median / High Price $21.31 / $74.55 / $133.69	Professional		$21.31	$74.55	$133.69
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $16.27 / $21.52 / $33.27	Professional	26	$16.27	$21.52	$33.27
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $50.79 / $71.33 / $115.72	Professional	TC	$50.79	$71.33	$115.72
United Facility/Professional Professional Modifier Low / Median / High Price $53.69 / $81.55 / $125.52	Professional		$53.69	$81.55	$125.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.49 / $19.79 / $32.75	Professional	26	$12.49	$19.79	$32.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.61 / $61.76 / $97.32	Professional	TC	$40.61	$61.76	$97.32