Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.87 / $13.68 / $54.01	Facility	26	$12.87	$13.68	$54.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.43 / $49.17 / $90.90	Professional		$42.43	$49.17	$90.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.73 / $13.67 / $21.87	Professional	26	$11.73	$13.67	$21.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.34 / $35.56 / $68.23	Professional	TC	$30.34	$35.56	$68.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.17 / $61.49 / $102.73	Professional		$49.17	$61.49	$102.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.63 / $16.14 / $25.64	Professional	26	$12.63	$16.14	$25.64
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.26 / $45.34 / $76.66	Professional	TC	$36.26	$45.34	$76.66
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $61.82 / $61.90 / $258.77	Professional		$61.82	$61.90	$258.77
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $16.84 / $16.92 / $21.49	Professional	26	$16.84	$16.92	$21.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $44.98 / $44.98 / $57.12	Professional	TC	$44.98	$44.98	$57.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.20 / $16.20 / $16.20	Facility	26	$16.20	$16.20	$16.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.43 / $70.70 / $118.69	Professional		$43.43	$70.70	$118.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.43 / $19.13 / $31.64	Professional	26	$11.43	$19.13	$31.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.45 / $51.24 / $85.40	Professional	TC	$31.45	$51.24	$85.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.96 / $62.35 / $74.59	Professional		$51.96	$62.35	$74.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.65 / $15.62 / $19.30	Professional	26	$12.65	$15.62	$19.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.31 / $47.18 / $55.50	Professional	TC	$39.31	$47.18	$55.50
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $16.89 / $22.48 / $44.97	Facility	26	$16.89	$22.48	$44.97
Medcost Facility/Professional Professional Modifier Low / Median / High Price $20.00 / $56.28 / $97.00	Professional		$20.00	$56.28	$97.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $20.80 / $68.61 / $115.67	Professional		$20.80	$68.61	$115.67
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $15.24 / $22.19 / $35.07	Professional	26	$15.24	$22.19	$35.07
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $40.36 / $58.70 / $89.68	Professional	TC	$40.36	$58.70	$89.68
United Facility/Professional Professional Modifier Low / Median / High Price $42.94 / $64.42 / $108.23	Professional		$42.94	$64.42	$108.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.57 / $18.11 / $30.07	Professional	26	$11.57	$18.11	$30.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.87 / $46.31 / $78.08	Professional	TC	$30.87	$46.31	$78.08