Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.17 / $18.10 / $35.11	Facility	26	$10.17	$18.10	$35.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.14 / $47.15 / $77.47	Professional		$37.14	$47.15	$77.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.52 / $11.06 / $18.96	Professional	26	$9.52	$11.06	$18.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.89 / $37.36 / $60.89	Professional	TC	$27.89	$37.36	$60.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.60 / $59.36 / $86.92	Professional		$43.60	$59.36	$86.92
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.44 / $13.06 / $19.69	Professional	26	$10.44	$13.06	$19.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.15 / $46.67 / $68.22	Professional	TC	$33.15	$46.67	$68.22
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $53.59 / $59.56 / $138.16	Professional		$53.59	$59.56	$138.16
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.77 / $13.44 / $17.07	Professional	26	$12.77	$13.44	$17.07
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $40.15 / $43.13 / $53.91	Professional	TC	$40.15	$43.13	$53.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.10 / $13.10 / $13.10	Facility	26	$13.10	$13.10	$13.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.30 / $60.82 / $108.95	Professional		$41.30	$60.82	$108.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.23 / $15.13 / $25.76	Professional	26	$9.23	$15.13	$25.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.88 / $45.22 / $86.70	Professional	TC	$31.88	$45.22	$86.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.20 / $61.44 / $75.30	Professional		$51.20	$61.44	$75.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.24 / $12.65 / $15.25	Professional	26	$10.24	$12.65	$15.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.96 / $49.15 / $60.24	Professional	TC	$40.96	$49.15	$60.24
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $20.00 / $36.26	Facility	26	$17.32	$20.00	$36.26
Medcost Facility/Professional Professional Modifier Low / Median / High Price $16.00 / $52.00 / $85.00	Professional		$16.00	$52.00	$85.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $16.52 / $58.52 / $104.99	Professional		$16.52	$58.52	$104.99
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $11.99 / $16.45 / $25.71	Professional	26	$11.99	$16.45	$25.71
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $39.72 / $55.07 / $91.33	Professional	TC	$39.72	$55.07	$91.33
United Facility/Professional Professional Modifier Low / Median / High Price $40.98 / $61.66 / $94.23	Professional		$40.98	$61.66	$94.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.42 / $14.51 / $22.79	Professional	26	$9.42	$14.51	$22.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.75 / $44.31 / $72.26	Professional	TC	$30.75	$44.31	$72.26