Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.91 / $31.59 / $56.63	Facility	26	$20.91	$31.59	$56.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.06 / $53.26 / $110.77	Professional		$42.06	$53.26	$110.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.78 / $22.60 / $45.64	Professional	26	$18.78	$22.60	$45.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.07 / $25.02 / $65.34	Professional	TC	$21.07	$25.02	$65.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.48 / $57.74 / $83.82	Professional		$45.48	$57.74	$83.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.23 / $25.89 / $37.19	Professional	26	$20.23	$25.89	$37.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.97 / $31.05 / $51.33	Professional	TC	$23.97	$31.05	$51.33
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $57.17 / $57.33 / $290.83	Professional		$57.17	$57.33	$290.83
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $25.00 / $27.78 / $52.50	Professional	26	$25.00	$27.78	$52.50
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $29.54 / $29.54 / $57.60	Professional	TC	$29.54	$29.54	$57.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.65 / $26.65 / $26.65	Facility	26	$26.65	$26.65	$26.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.90 / $74.01 / $129.77	Professional		$39.90	$74.01	$129.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $25.80 / $54.69	Professional	26	$17.05	$25.80	$54.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.70 / $41.00 / $93.50	Professional	TC	$20.70	$41.00	$93.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $47.29 / $58.41 / $70.76	Professional		$47.29	$58.41	$70.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.07 / $26.77 / $33.18	Professional	26	$21.07	$26.77	$33.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.39 / $32.38 / $38.54	Professional	TC	$25.39	$32.38	$38.54
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $27.90 / $32.00 / $65.98	Facility	26	$27.90	$32.00	$65.98
Medcost Facility/Professional Professional Modifier Low / Median / High Price $29.00 / $60.00 / $137.79	Professional		$29.00	$60.00	$137.79
Sentara Facility/Professional Professional Modifier Low / Median / High Price $25.14 / $79.59 / $141.09	Professional		$25.14	$79.59	$141.09
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $22.29 / $31.45 / $52.15	Professional	26	$22.29	$31.45	$52.15
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $26.32 / $46.45 / $93.76	Professional	TC	$26.32	$46.45	$93.76
United Facility/Professional Professional Modifier Low / Median / High Price $39.25 / $66.23 / $116.23	Professional		$39.25	$66.23	$116.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.08 / $25.26 / $39.76	Professional	26	$15.08	$25.26	$39.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $36.18 / $93.25	Professional	TC	$19.14	$36.18	$93.25