Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.36 / $14.88 / $29.87	Facility	26	$8.36	$14.88	$29.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.26 / $25.90 / $171.00	Professional		$22.26	$25.90	$171.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.36 / $10.02 / $23.06	Professional	26	$8.36	$10.02	$23.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $13.11 / $15.71 / $119.70	Professional	TC	$13.11	$15.71	$119.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $0.02 / $33.72 / $71.83	Professional		$0.02	$33.72	$71.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $5.09 / $9.85 / $13.30	Professional	26	$5.09	$9.85	$13.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $12.61 / $23.27 / $61.79	Professional	TC	$12.61	$23.27	$61.79
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $25.22 / $27.60 / $245.74	Professional		$25.22	$27.60	$245.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.23 / $10.26 / $13.03	Professional	26	$9.23	$10.26	$13.03
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $14.96 / $17.34 / $54.73	Professional	TC	$14.96	$17.34	$54.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.80 / $10.80 / $10.80	Facility	26	$10.80	$10.80	$10.80
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $5.59 / $5.59 / $5.59	Facility	53	$5.59	$5.59	$5.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $20.59 / $41.34 / $162.29	Professional		$20.59	$41.34	$162.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $12.44 / $20.91	Professional	26	$7.59	$12.44	$20.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.33 / $24.02 / $148.44	Professional	TC	$12.33	$24.02	$148.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $24.48 / $29.38 / $34.56	Professional		$24.48	$29.38	$34.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.42 / $10.41 / $12.54	Professional	26	$8.42	$10.41	$12.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $16.05 / $19.27 / $22.67	Professional	TC	$16.05	$19.27	$22.67
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $10.98 / $16.55 / $33.95	Facility	26	$10.98	$16.55	$33.95
Medcost Facility/Professional Professional Modifier Low / Median / High Price $12.43 / $28.00 / $111.00	Professional		$12.43	$28.00	$111.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $13.14 / $43.17 / $154.93	Professional		$13.14	$43.17	$154.93
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $9.92 / $13.60 / $21.16	Professional	26	$9.92	$13.60	$21.16
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $15.07 / $26.89 / $109.09	Professional	TC	$15.07	$26.89	$109.09
United Facility/Professional Professional Modifier Low / Median / High Price $18.60 / $34.71 / $184.46	Professional		$18.60	$34.71	$184.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $12.01 / $19.09	Professional	26	$7.24	$12.01	$19.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.56 / $20.02 / $150.53	Professional	TC	$10.56	$20.02	$150.53