Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.42 / $21.30 / $52.97	Facility	26	$15.42	$21.30	$52.97
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.54 / $70.62 / $616.47	Facility	TC	$26.54	$70.62	$616.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.19 / $42.46 / $75.06	Professional		$35.19	$42.46	$75.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.51 / $14.49 / $28.86	Professional	26	$11.51	$14.49	$28.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.28 / $28.17 / $54.21	Professional	TC	$22.28	$28.17	$54.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.28 / $51.26 / $77.64	Professional		$40.28	$51.26	$77.64
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.29 / $15.75 / $23.54	Professional	26	$12.29	$15.75	$23.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.11 / $35.09 / $54.02	Professional	TC	$28.11	$35.09	$54.02
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $50.53 / $51.23 / $159.60	Professional		$50.53	$51.23	$159.60
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $17.53 / $18.23 / $23.15	Professional	26	$17.53	$18.23	$23.15
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $33.00 / $33.00 / $41.91	Professional	TC	$33.00	$33.00	$41.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.41 / $15.41 / $15.41	Facility	26	$15.41	$15.41	$15.41
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.04 / $35.04 / $35.04	Facility	TC	$35.04	$35.04	$35.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.85 / $60.37 / $101.34	Professional		$35.85	$60.37	$101.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.95 / $19.47 / $34.49	Professional	26	$10.95	$19.47	$34.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.13 / $39.54 / $66.81	Professional	TC	$25.13	$39.54	$66.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.87 / $51.44 / $63.15	Professional		$42.87	$51.44	$63.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.06 / $14.90 / $17.95	Professional	26	$12.06	$14.90	$17.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.80 / $36.96 / $45.30	Professional	TC	$30.80	$36.96	$45.30
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $23.58 / $28.00 / $49.17	Facility	26	$23.58	$28.00	$49.17
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $35.07 / $50.52 / $90.16	Facility	TC	$35.07	$50.52	$90.16
Medcost Facility/Professional Professional Modifier Low / Median / High Price $22.00 / $43.84 / $78.00	Professional		$22.00	$43.84	$78.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $22.36 / $57.52 / $100.60	Professional		$22.36	$57.52	$100.60
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $15.11 / $21.03 / $31.72	Professional	26	$15.11	$21.03	$31.72
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $31.49 / $43.36 / $68.66	Professional	TC	$31.49	$43.36	$68.66
United Facility/Professional Professional Modifier Low / Median / High Price $35.50 / $55.06 / $89.48	Professional		$35.50	$55.06	$89.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.65 / $17.67 / $29.68	Professional	26	$11.65	$17.67	$29.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.72 / $35.59 / $60.29	Professional	TC	$23.72	$35.59	$60.29