Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.12 / $16.95 / $69.33	Facility	26	$13.12	$16.95	$69.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.64 / $48.17 / $61.17	Professional		$42.64	$48.17	$61.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $15.06 / $18.59	Professional	26	$12.88	$15.06	$18.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.92 / $33.85 / $44.32	Professional	TC	$29.92	$33.85	$44.32
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.57 / $51.88 / $77.81	Professional		$40.57	$51.88	$77.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.91 / $16.51 / $24.76	Professional	26	$12.91	$16.51	$24.76
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.65 / $35.36 / $53.10	Professional	TC	$27.65	$35.36	$53.10
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $57.19 / $57.19 / $114.38	Professional		$57.19	$57.19	$114.38
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $15.45 / $15.45 / $29.20	Professional	26	$15.45	$15.45	$29.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $41.74 / $41.74 / $78.89	Professional	TC	$41.74	$41.74	$78.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.49 / $69.51 / $125.94	Professional		$45.49	$69.51	$125.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.87 / $19.73 / $37.22	Professional	26	$13.87	$19.73	$37.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.60 / $48.47 / $88.71	Professional	TC	$31.60	$48.47	$88.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $46.44 / $93.68	Professional		$37.15	$46.44	$93.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.56 / $14.45 / $25.56	Professional	26	$11.56	$14.45	$25.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.59 / $31.99 / $68.12	Professional	TC	$25.59	$31.99	$68.12
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $17.23 / $19.61 / $38.63	Facility	26	$17.23	$19.61	$38.63
Medcost Facility/Professional Professional Modifier Low / Median / High Price $20.00 / $53.87 / $88.00	Professional		$20.00	$53.87	$88.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $18.07 / $53.71 / $97.13	Professional		$18.07	$53.71	$97.13
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $14.96 / $18.89 / $31.34	Professional	26	$14.96	$18.89	$31.34
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $33.27 / $45.19 / $77.53	Professional	TC	$33.27	$45.19	$77.53
United Facility/Professional Professional Modifier Low / Median / High Price $43.89 / $64.50 / $101.41	Professional		$43.89	$64.50	$101.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.36 / $17.92 / $29.36	Professional	26	$12.36	$17.92	$29.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $45.44 / $71.65	Professional	TC	$29.51	$45.44	$71.65