Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.27 / $27.65 / $83.89	Facility	26	$16.27	$27.65	$83.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.40 / $64.03 / $110.19	Professional		$49.40	$64.03	$110.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.27 / $20.51 / $36.32	Professional	26	$16.27	$20.51	$36.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.40 / $38.70 / $77.48	Professional	TC	$32.40	$38.70	$77.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.81 / $59.74 / $90.50	Professional		$46.81	$59.74	$90.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.20 / $20.44 / $30.65	Professional	26	$16.20	$20.44	$30.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.73 / $39.29 / $63.66	Professional	TC	$30.73	$39.29	$63.66
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $52.73 / $58.59 / $293.50	Professional		$52.73	$58.59	$293.50
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $18.92 / $19.66 / $37.15	Professional	26	$18.92	$19.66	$37.15
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $34.58 / $34.58 / $67.43	Professional	TC	$34.58	$34.58	$67.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.10 / $20.10 / $20.10	Facility	26	$20.10	$20.10	$20.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.73 / $80.31 / $133.07	Professional		$52.73	$80.31	$133.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.82 / $25.11 / $45.92	Professional	26	$17.82	$25.11	$45.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.33 / $52.82 / $93.56	Professional	TC	$34.33	$52.82	$93.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $47.74 / $58.97 / $72.12	Professional		$47.74	$58.97	$72.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.62 / $19.85 / $24.72	Professional	26	$15.62	$19.85	$24.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.12 / $39.67 / $48.88	Professional	TC	$31.12	$39.67	$48.88
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $21.15 / $48.52 / $80.00	Facility	26	$21.15	$48.52	$80.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $24.00 / $52.00 / $108.00	Professional		$24.00	$52.00	$108.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $25.20 / $68.38 / $122.56	Professional		$25.20	$68.38	$122.56
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $19.57 / $25.91 / $39.44	Professional	26	$19.57	$25.91	$39.44
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $38.00 / $51.68 / $82.20	Professional	TC	$38.00	$51.68	$82.20
United Facility/Professional Professional Modifier Low / Median / High Price $48.17 / $77.25 / $123.95	Professional		$48.17	$77.25	$123.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.95 / $22.64 / $36.60	Professional	26	$14.95	$22.64	$36.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.70 / $49.44 / $90.32	Professional	TC	$29.70	$49.44	$90.32