Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.29 / $19.67 / $60.02	Facility	26	$15.29	$19.67	$60.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.69 / $68.64 / $115.53	Professional		$53.69	$68.64	$115.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.26 / $16.30 / $23.08	Professional	26	$13.26	$16.30	$23.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.06 / $53.15 / $92.52	Professional	TC	$41.06	$53.15	$92.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.66 / $91.05 / $135.38	Professional		$67.66	$91.05	$135.38
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.33 / $19.69 / $29.31	Professional	26	$15.33	$19.69	$29.31
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $52.51 / $71.54 / $105.86	Professional	TC	$52.51	$71.54	$105.86
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $74.56 / $88.71 / $141.61	Professional		$74.56	$88.71	$141.61
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $19.71 / $19.71 / $25.03	Professional	26	$19.71	$19.71	$25.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $54.86 / $62.98 / $78.72	Professional	TC	$54.86	$62.98	$78.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.60 / $19.60 / $19.60	Facility	26	$19.60	$19.60	$19.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.68 / $88.35 / $166.46	Professional		$60.68	$88.35	$166.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.86 / $22.29 / $38.20	Professional	26	$13.86	$22.29	$38.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.03 / $66.44 / $129.47	Professional	TC	$47.03	$66.44	$129.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $77.34 / $92.81 / $113.74	Professional		$77.34	$92.81	$113.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.41 / $19.04 / $22.90	Professional	26	$15.41	$19.04	$22.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $61.93 / $74.31 / $91.08	Professional	TC	$61.93	$74.31	$91.08
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $26.12 / $26.12 / $53.72	Facility	26	$26.12	$26.12	$53.72
Medcost Facility/Professional Professional Modifier Low / Median / High Price $22.00 / $73.00 / $143.00	Professional		$22.00	$73.00	$143.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $23.19 / $80.97 / $149.68	Professional		$23.19	$80.97	$149.68
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $17.70 / $24.37 / $38.58	Professional	26	$17.70	$24.37	$38.58
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $55.13 / $77.65 / $129.05	Professional	TC	$55.13	$77.65	$129.05
United Facility/Professional Professional Modifier Low / Median / High Price $61.21 / $94.87 / $150.59	Professional		$61.21	$94.87	$150.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.85 / $21.96 / $35.44	Professional	26	$13.85	$21.96	$35.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.34 / $70.92 / $113.15	Professional	TC	$46.34	$70.92	$113.15