Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $35.48 / $53.70	Facility	26	$30.20	$35.48	$53.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $53.70 / $120.23	Professional		$33.11	$53.70	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $29.51 / $66.07	Professional	26	$23.44	$29.51	$66.07
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $33.11 / $309.03 / $323.59	Professional	52	$33.11	$309.03	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $22.91 / $38.90	Professional	TC	$15.85	$22.91	$38.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $0.02 / $51.29 / $77.62	Professional		$0.02	$51.29	$77.62
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $31.62 / $45.71	Professional	26	$26.30	$31.62	$45.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $25.12 / $40.74	Professional	TC	$18.62	$25.12	$40.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.61 / $30.90 / $43.65	Facility	26	$6.61	$30.90	$43.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $38.90 / $38.90	Professional		$38.90	$38.90	$38.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $25.12 / $25.12	Professional	26	$25.12	$25.12	$25.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $14.13 / $14.13	Professional	TC	$14.13	$14.13	$14.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $47.86 / $74.13	Professional		$38.02	$47.86	$74.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $31.62 / $40.74	Professional	26	$25.70	$31.62	$40.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $12.59 / $15.14 / $25.70	Professional	TC	$12.59	$15.14	$25.70
Medcost Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $58.88 / $58.88	Professional		$58.88	$58.88	$58.88
Sentara Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $54.95 / $100.00	Professional		$25.70	$54.95	$100.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $35.48 / $64.57	Professional	26	$29.51	$35.48	$64.57
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $29.51 / $51.29	Professional	TC	$22.39	$29.51	$51.29
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $66.07 / $104.71	Professional		$39.81	$66.07	$104.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $35.48 / $57.54	Professional	26	$21.88	$35.48	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $30.20 / $48.98	Professional	TC	$18.20	$30.20	$48.98