Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.50 / $34.71 / $99.84	Facility	26	$19.50	$34.71	$99.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.10 / $50.41 / $70.03	Professional		$27.10	$50.41	$70.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.35 / $21.77 / $33.14	Professional	26	$18.35	$21.77	$33.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $8.74 / $27.62 / $38.65	Professional	TC	$8.74	$27.62	$38.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.80 / $62.49 / $93.73	Professional		$47.80	$62.49	$93.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.73 / $23.97 / $35.96	Professional	26	$18.73	$23.97	$35.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.46 / $38.51 / $57.77	Professional	TC	$29.46	$38.51	$57.77
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $58.53 / $58.53 / $117.06	Professional		$58.53	$58.53	$117.06
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $23.27 / $23.27 / $43.98	Professional	26	$23.27	$23.27	$43.98
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $35.26 / $35.26 / $66.64	Professional	TC	$35.26	$35.26	$66.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $53.45 / $117.85	Professional		$34.67	$53.45	$117.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.03 / $27.51 / $53.56	Professional	26	$20.03	$27.51	$53.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $11.20 / $28.53 / $65.37	Professional	TC	$11.20	$28.53	$65.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.60 / $58.25 / $84.66	Professional		$46.60	$58.25	$84.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.30 / $21.63 / $37.04	Professional	26	$17.30	$21.63	$37.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.13 / $36.61 / $47.63	Professional	TC	$24.13	$36.61	$47.63
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $22.35 / $24.77 / $55.51	Facility	26	$22.35	$24.77	$55.51
Medcost Facility/Professional Professional Modifier Low / Median / High Price $13.00 / $35.00 / $72.00	Professional		$13.00	$35.00	$72.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $13.35 / $35.71 / $88.23	Professional		$13.35	$35.71	$88.23
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $20.84 / $25.25 / $44.10	Professional	26	$20.84	$25.25	$44.10
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $9.60 / $25.72 / $59.77	Professional	TC	$9.60	$25.72	$59.77
United Facility/Professional Professional Modifier Low / Median / High Price $28.83 / $47.94 / $87.36	Professional		$28.83	$47.94	$87.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.69 / $24.99 / $40.29	Professional	26	$16.69	$24.99	$40.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.29 / $25.40 / $49.21	Professional	TC	$10.29	$25.40	$49.21