Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.78 / $20.10 / $43.63	Facility	26	$13.78	$20.10	$43.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.89 / $46.56 / $81.61	Professional		$40.89	$46.56	$81.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.09 / $14.64 / $32.25	Professional	26	$13.09	$14.64	$32.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.85 / $31.88 / $58.19	Professional	TC	$26.85	$31.88	$58.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.51 / $56.00 / $82.62	Professional		$42.51	$56.00	$82.62
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.46 / $17.30 / $25.96	Professional	26	$13.46	$17.30	$25.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.71 / $39.20 / $57.30	Professional	TC	$26.71	$39.20	$57.30
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $52.08 / $55.03 / $135.75	Professional		$52.08	$55.03	$135.75
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $16.30 / $16.30 / $20.70	Professional	26	$16.30	$16.30	$20.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $34.86 / $35.78 / $45.44	Professional	TC	$34.86	$35.78	$45.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.36 / $17.36 / $17.36	Facility	26	$17.36	$17.36	$17.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.11 / $59.31 / $102.59	Professional		$39.11	$59.31	$102.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.15 / $19.95 / $34.42	Professional	26	$12.15	$19.95	$34.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.14 / $39.22 / $71.55	Professional	TC	$27.14	$39.22	$71.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $47.95 / $57.54 / $70.61	Professional		$47.95	$57.54	$70.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.87 / $17.14 / $20.66	Professional	26	$13.87	$17.14	$20.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.08 / $40.89 / $50.11	Professional	TC	$34.08	$40.89	$50.11
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $23.19 / $32.54 / $47.31	Facility	26	$23.19	$32.54	$47.31
Medcost Facility/Professional Professional Modifier Low / Median / High Price $21.00 / $46.00 / $82.37	Professional		$21.00	$46.00	$82.37
Sentara Facility/Professional Professional Modifier Low / Median / High Price $21.41 / $56.73 / $109.46	Professional		$21.41	$56.73	$109.46
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $15.90 / $21.50 / $34.04	Professional	26	$15.90	$21.50	$34.04
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $33.76 / $46.89 / $75.44	Professional	TC	$33.76	$46.89	$75.44
United Facility/Professional Professional Modifier Low / Median / High Price $38.46 / $58.42 / $92.67	Professional		$38.46	$58.42	$92.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.24 / $18.93 / $32.02	Professional	26	$12.24	$18.93	$32.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.91 / $36.33 / $59.11	Professional	TC	$24.91	$36.33	$59.11