Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $23.44 / $107.15	Facility	26	$10.96	$23.44	$107.15
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $70.79 / $616.60	Facility	TC	$30.20	$70.79	$616.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $47.86 / $97.72	Professional		$36.31	$47.86	$97.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.95 / $54.95	Professional	26	$10.96	$19.95	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $32.36 / $60.26	Professional	TC	$23.99	$32.36	$60.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $57.54 / $89.13	Professional		$42.66	$57.54	$89.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $17.78 / $27.54	Professional	26	$12.88	$17.78	$27.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $39.81 / $61.66	Professional	TC	$28.84	$39.81	$61.66
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $51.29 / $186.21	Professional		$18.20	$51.29	$186.21
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $14.13 / $21.38	Professional	26	$12.88	$14.13	$21.38
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $36.31 / $54.95	Professional	TC	$32.36	$36.31	$54.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.24 / $15.14 / $21.88	Facility	26	$3.24	$15.14	$21.88
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $7.24 / $33.88 / $48.98	Facility	TC	$7.24	$33.88	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $58.88 / $97.72	Professional		$35.48	$58.88	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.50 / $32.36	Professional	26	$10.96	$19.50	$32.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $38.90 / $66.07	Professional	TC	$24.55	$38.90	$66.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $51.29 / $64.57	Professional		$42.66	$51.29	$64.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $14.79 / $19.05	Professional	26	$12.02	$14.79	$19.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $37.15 / $46.77	Professional	TC	$30.20	$37.15	$46.77
Medcost Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $85.11 / $97.72	Professional		$67.61	$85.11	$97.72
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $29.51 / $30.20	Professional	26	$23.99	$29.51	$30.20
Medcost Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $44.67 / $72.44	Professional		$44.67	$44.67	$72.44
Sentara Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $52.48 / $245.47	Professional		$20.42	$52.48	$245.47
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $20.89 / $33.88	Professional	26	$13.80	$20.89	$33.88
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $40.74 / $69.18	Professional	TC	$30.20	$40.74	$69.18
United Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $51.29 / $91.20	Professional		$34.67	$51.29	$91.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $16.98 / $30.20	Professional	26	$11.48	$16.98	$30.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $34.67 / $61.66	Professional	TC	$23.44	$34.67	$61.66