Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.66 / $28.32 / $83.85	Facility	26	$16.66	$28.32	$83.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.43 / $47.13 / $76.62	Professional		$35.43	$47.13	$76.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.66 / $20.50 / $32.45	Professional	26	$16.66	$20.50	$32.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $13.19 / $30.22 / $40.08	Professional	TC	$13.19	$30.22	$40.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.89 / $57.38 / $86.07	Professional		$43.89	$57.38	$86.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.98 / $20.44 / $30.65	Professional	26	$15.98	$20.44	$30.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.25 / $36.94 / $55.42	Professional	TC	$28.25	$36.94	$55.42
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $54.26 / $54.26 / $152.22	Professional		$54.26	$54.26	$152.22
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $20.36 / $20.36 / $38.47	Professional	26	$20.36	$20.36	$38.47
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $33.90 / $33.90 / $64.06	Professional	TC	$33.90	$33.90	$64.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.96 / $54.95 / $110.40	Professional		$40.96	$54.95	$110.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.37 / $26.18 / $46.79	Professional	26	$17.37	$26.18	$46.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.66 / $28.32 / $63.30	Professional	TC	$17.66	$28.32	$63.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $43.11 / $53.89 / $77.25	Professional		$43.11	$53.89	$77.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.74 / $18.43 / $31.62	Professional	26	$14.74	$18.43	$31.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.47 / $35.46 / $47.87	Professional	TC	$25.47	$35.46	$47.87
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $24.37 / $28.37 / $47.58	Facility	26	$24.37	$28.37	$47.58
Medcost Facility/Professional Professional Modifier Low / Median / High Price $20.00 / $37.00 / $69.00	Professional		$20.00	$37.00	$69.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $18.29 / $41.31 / $81.11	Professional		$18.29	$41.31	$81.11
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $18.44 / $25.36 / $40.10	Professional	26	$18.44	$25.36	$40.10
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $15.04 / $29.21 / $57.26	Professional	TC	$15.04	$29.21	$57.26
United Facility/Professional Professional Modifier Low / Median / High Price $34.33 / $50.49 / $83.75	Professional		$34.33	$50.49	$83.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.81 / $22.84 / $37.49	Professional	26	$15.81	$22.84	$37.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.02 / $25.07 / $45.63	Professional	TC	$16.02	$25.07	$45.63