Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.21 / $23.42 / $48.33	Facility	26	$13.21	$23.42	$48.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.00 / $59.94 / $111.22	Professional		$51.00	$59.94	$111.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.51 / $14.96 / $35.45	Professional	26	$12.51	$14.96	$35.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.97 / $46.74 / $82.06	Professional	TC	$36.97	$46.74	$82.06
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.31 / $70.39 / $104.90	Professional		$55.31	$70.39	$104.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.92 / $16.89 / $24.91	Professional	26	$12.92	$16.89	$24.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.13 / $54.09 / $79.30	Professional	TC	$42.13	$54.09	$79.30
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $69.15 / $70.14 / $198.12	Professional		$69.15	$70.14	$198.12
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $17.27 / $18.27 / $23.20	Professional	26	$17.27	$18.27	$23.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $51.24 / $51.88 / $65.89	Professional	TC	$51.24	$51.88	$65.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.86 / $80.27 / $132.13	Professional		$48.86	$80.27	$132.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $20.73 / $34.95	Professional	26	$11.77	$20.73	$34.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.74 / $59.79 / $98.37	Professional	TC	$37.74	$59.79	$98.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $59.17 / $71.00 / $87.01	Professional		$59.17	$71.00	$87.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.29 / $16.42 / $19.80	Professional	26	$13.29	$16.42	$19.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $45.87 / $55.05 / $67.45	Professional	TC	$45.87	$55.05	$67.45
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $26.10 / $30.00 / $53.10	Facility	26	$26.10	$30.00	$53.10
Medcost Facility/Professional Professional Modifier Low / Median / High Price $22.00 / $69.76 / $110.66	Professional		$22.00	$69.76	$110.66
Sentara Facility/Professional Professional Modifier Low / Median / High Price $24.12 / $76.97 / $136.63	Professional		$24.12	$76.97	$136.63
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $16.62 / $22.03 / $32.61	Professional	26	$16.62	$22.03	$32.61
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $47.59 / $65.78 / $102.97	Professional	TC	$47.59	$65.78	$102.97
United Facility/Professional Professional Modifier Low / Median / High Price $47.81 / $71.77 / $120.49	Professional		$47.81	$71.77	$120.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.03 / $18.53 / $31.43	Professional	26	$12.03	$18.53	$31.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.46 / $53.18 / $89.36	Professional	TC	$35.46	$53.18	$89.36