Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.53 / $33.75 / $81.23	Facility	26	$18.53	$33.75	$81.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.81 / $60.51 / $104.37	Professional		$49.81	$60.51	$104.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.30 / $19.59 / $34.61	Professional	26	$17.30	$19.59	$34.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.50 / $39.82 / $67.65	Professional	TC	$32.50	$39.82	$67.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.92 / $73.87 / $106.96	Professional		$58.92	$73.87	$106.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $24.22 / $34.26	Professional	26	$19.05	$24.22	$34.26
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.50 / $50.14 / $72.53	Professional	TC	$37.50	$50.14	$72.53
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $75.22 / $75.22 / $208.20	Professional		$75.22	$75.22	$208.20
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $23.75 / $23.75 / $30.16	Professional	26	$23.75	$23.75	$30.16
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $46.33 / $51.47 / $65.37	Professional	TC	$46.33	$51.47	$65.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.92 / $23.92 / $23.92	Facility	26	$23.92	$23.92	$23.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.06 / $83.53 / $139.47	Professional		$53.06	$83.53	$139.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.80 / $26.98 / $46.29	Professional	26	$16.80	$26.98	$46.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.11 / $54.59 / $91.52	Professional	TC	$36.11	$54.59	$91.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $62.59 / $75.09 / $92.38	Professional		$62.59	$75.09	$92.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.67 / $23.07 / $27.79	Professional	26	$18.67	$23.07	$27.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $43.91 / $52.69 / $64.58	Professional	TC	$43.91	$52.69	$64.58
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $24.33 / $48.46 / $78.40	Facility	26	$24.33	$48.46	$78.40
Medcost Facility/Professional Professional Modifier Low / Median / High Price $29.00 / $67.00 / $114.00	Professional		$29.00	$67.00	$114.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $29.81 / $77.73 / $147.58	Professional		$29.81	$77.73	$147.58
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $20.95 / $33.10 / $52.57	Professional	26	$20.95	$33.10	$52.57
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $41.88 / $66.66 / $105.25	Professional	TC	$41.88	$66.66	$105.25
United Facility/Professional Professional Modifier Low / Median / High Price $50.33 / $76.45 / $129.02	Professional		$50.33	$76.45	$129.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.17 / $26.61 / $42.39	Professional	26	$17.17	$26.61	$42.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.88 / $49.32 / $78.36	Professional	TC	$32.88	$49.32	$78.36