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 $50.47 / $57.44 / $104.72	Professional		$50.47	$57.44	$104.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.55 / $14.64 / $29.34	Professional	26	$12.55	$14.64	$29.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.11 / $42.13 / $81.43	Professional	TC	$37.11	$42.13	$81.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.29 / $71.16 / $105.80	Professional		$53.29	$71.16	$105.80
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 $39.72 / $53.94 / $80.20	Professional	TC	$39.72	$53.94	$80.20
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $62.32 / $70.12 / $128.27	Professional		$62.32	$70.12	$128.27
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 $44.12 / $47.58 / $59.47	Professional	TC	$44.12	$47.58	$59.47
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 $48.08 / $73.88 / $128.69	Professional		$48.08	$73.88	$128.69
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 $35.65 / $52.43 / $95.62	Professional	TC	$35.65	$52.43	$95.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $59.79 / $71.75 / $87.93	Professional		$59.79	$71.75	$87.93
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 $46.21 / $55.45 / $67.95	Professional	TC	$46.21	$55.45	$67.95
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $27.36 / $42.22 / $55.44	Facility	26	$27.36	$42.22	$55.44
Medcost Facility/Professional Professional Modifier Low / Median / High Price $20.00 / $57.00 / $109.10	Professional		$20.00	$57.00	$109.10
Sentara Facility/Professional Professional Modifier Low / Median / High Price $21.32 / $67.75 / $125.36	Professional		$21.32	$67.75	$125.36
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 $43.24 / $60.74 / $97.49	Professional	TC	$43.24	$60.74	$97.49
United Facility/Professional Professional Modifier Low / Median / High Price $46.93 / $71.29 / $113.35	Professional		$46.93	$71.29	$113.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.55 / $19.01 / $31.00	Professional	26	$12.55	$19.01	$31.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.15 / $51.90 / $80.59	Professional	TC	$34.15	$51.90	$80.59