Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $19.95 / $50.12	Facility	26	$10.96	$19.95	$50.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $67.61 / $144.54	Professional		$41.69	$67.61	$144.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $20.42 / $51.29	Professional	26	$10.96	$20.42	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $47.86 / $87.10	Professional	TC	$30.90	$47.86	$87.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $66.07 / $104.71	Professional		$48.98	$66.07	$104.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $16.22 / $25.12	Professional	26	$11.48	$16.22	$25.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $50.12 / $77.62	Professional	TC	$36.31	$50.12	$77.62
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $13.49 / $53.70 / $158.49	Professional		$13.49	$53.70	$158.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $16.98 / $20.89	Professional	26	$14.13	$16.98	$20.89
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $45.71 / $63.10	Professional	TC	$38.90	$45.71	$63.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.09 / $14.45 / $20.89	Facility	26	$3.09	$14.45	$20.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $63.10 / $107.15	Professional		$41.69	$63.10	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $17.78 / $30.20	Professional	26	$10.23	$17.78	$30.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $44.67 / $81.28	Professional	TC	$30.20	$44.67	$81.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $63.10 / $77.62	Professional		$52.48	$63.10	$77.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $14.45 / $18.20	Professional	26	$11.75	$14.45	$18.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $48.98 / $60.26	Professional	TC	$39.81	$48.98	$60.26
Medcost Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $81.28 / $109.65	Professional		$66.07	$81.28	$109.65
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $26.92 / $26.92	Professional	26	$21.38	$26.92	$26.92
Medcost Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $83.18	Professional		$50.12	$50.12	$83.18
Sentara Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $57.54 / $251.19	Professional		$18.20	$57.54	$251.19
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $18.20 / $30.20	Professional	26	$12.88	$18.20	$30.20
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $47.86 / $81.28	Professional	TC	$35.48	$47.86	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $57.54 / $97.72	Professional		$38.02	$57.54	$97.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $15.49 / $26.92	Professional	26	$10.47	$15.49	$26.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $40.74 / $70.79	Professional	TC	$27.54	$40.74	$70.79