Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.45 / $38.18 / $71.38	Facility	26	$21.45	$38.18	$71.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.61 / $60.53 / $132.62	Professional		$35.61	$60.53	$132.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.45 / $23.53 / $47.72	Professional	26	$21.45	$23.53	$47.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.16 / $25.59 / $82.16	Professional	TC	$14.16	$25.59	$82.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.26 / $46.37 / $76.66	Professional		$36.26	$46.37	$76.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.56 / $27.45 / $38.26	Professional	26	$21.56	$27.45	$38.26
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $14.44 / $18.47 / $30.53	Professional	TC	$14.44	$18.47	$30.53
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $45.56 / $87.29 / $300.18	Professional		$45.56	$87.29	$300.18
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $27.15 / $27.15 / $29.00	Professional	26	$27.15	$27.15	$29.00
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $18.41 / $18.41 / $57.87	Professional	TC	$18.41	$18.41	$57.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.11 / $27.11 / $27.11	Facility	26	$27.11	$27.11	$27.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.33 / $83.41 / $128.47	Professional		$36.33	$83.41	$128.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.74 / $33.96 / $59.95	Professional	26	$20.74	$33.96	$59.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.90 / $51.13 / $76.16	Professional	TC	$13.90	$51.13	$76.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.32 / $54.07 / $56.80	Professional		$40.32	$54.07	$56.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.58 / $30.94 / $34.08	Professional	26	$23.58	$30.94	$34.08
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $16.75 / $23.40 / $23.92	Professional	TC	$16.75	$23.40	$23.92
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $38.79 / $44.00 / $70.33	Facility	26	$38.79	$44.00	$70.33
Medcost Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $64.00 / $123.00	Professional		$30.00	$64.00	$123.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $27.41 / $62.22 / $148.96	Professional		$27.41	$62.22	$148.96
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $26.98 / $35.33 / $56.73	Professional	26	$26.98	$35.33	$56.73
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $18.60 / $43.82 / $78.64	Professional	TC	$18.60	$43.82	$78.64
United Facility/Professional Professional Modifier Low / Median / High Price $42.23 / $72.70 / $121.97	Professional		$42.23	$72.70	$121.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.52 / $31.72 / $48.46	Professional	26	$19.52	$31.72	$48.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.20 / $40.09 / $78.97	Professional	TC	$20.20	$40.09	$78.97