Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.59 / $29.54 / $120.82	Facility	26	$23.59	$29.54	$120.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.46 / $60.57 / $86.50	Professional		$42.46	$60.57	$86.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.93 / $28.82 / $46.23	Professional	26	$22.93	$28.82	$46.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.67 / $33.11 / $44.67	Professional	TC	$16.67	$33.11	$44.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.81 / $70.34 / $105.53	Professional		$53.81	$70.34	$105.53
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.74 / $29.08 / $43.62	Professional	26	$22.74	$29.08	$43.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.57 / $41.27 / $61.90	Professional	TC	$31.57	$41.27	$61.90
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $62.80 / $62.80 / $114.74	Professional		$62.80	$62.80	$114.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $25.14 / $25.14 / $47.51	Professional	26	$25.14	$25.14	$47.51
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $37.65 / $37.65 / $71.18	Professional	TC	$37.65	$37.65	$71.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.88 / $65.36 / $136.65	Professional		$47.88	$65.36	$136.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.40 / $34.51 / $64.90	Professional	26	$24.40	$34.51	$64.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.98 / $31.87 / $70.20	Professional	TC	$18.98	$31.87	$70.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $52.46 / $65.56 / $95.72	Professional		$52.46	$65.56	$95.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.00 / $26.25 / $44.79	Professional	26	$21.00	$26.25	$44.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.27 / $39.32 / $53.08	Professional	TC	$27.27	$39.32	$53.08
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $29.66 / $34.26 / $67.22	Facility	26	$29.66	$34.26	$67.22
Medcost Facility/Professional Professional Modifier Low / Median / High Price $22.00 / $44.15 / $82.00	Professional		$22.00	$44.15	$82.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $21.06 / $48.17 / $101.19	Professional		$21.06	$48.17	$101.19
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $33.04 / $53.72	Professional	26	$25.70	$33.04	$53.72
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $16.14 / $32.40 / $63.93	Professional	TC	$16.14	$32.40	$63.93
United Facility/Professional Professional Modifier Low / Median / High Price $40.83 / $60.79 / $99.04	Professional		$40.83	$60.79	$99.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.54 / $31.68 / $52.43	Professional	26	$21.54	$31.68	$52.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.93 / $28.04 / $50.60	Professional	TC	$16.93	$28.04	$50.60