Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.16 / $14.66 / $59.52	Facility	26	$13.16	$14.66	$59.52
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.69 / $89.07 / $659.85	Facility	TC	$23.69	$89.07	$659.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.86 / $40.96 / $58.65	Professional		$33.86	$40.96	$58.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.19 / $14.35 / $19.48	Professional	26	$12.19	$14.35	$19.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.36 / $27.13 / $41.61	Professional	TC	$21.36	$27.13	$41.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.21 / $52.56 / $78.73	Professional		$39.21	$52.56	$78.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.92 / $16.52 / $25.08	Professional	26	$12.92	$16.52	$25.08
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.12 / $35.17 / $53.47	Professional	TC	$26.12	$35.17	$53.47
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $50.37 / $51.91 / $244.25	Professional		$50.37	$51.91	$244.25
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $18.19 / $23.10	Professional	26	$17.23	$18.19	$23.10
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $32.18 / $32.18 / $40.22	Professional	TC	$32.18	$32.18	$40.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $16.60 / $16.60	Facility	26	$16.60	$16.60	$16.60
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 $35.63 / $54.46 / $95.90	Professional		$35.63	$54.46	$95.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.71 / $19.43 / $33.83	Professional	26	$11.71	$19.43	$33.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.73 / $33.19 / $63.19	Professional	TC	$23.73	$33.19	$63.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $43.73 / $52.48 / $64.31	Professional		$43.73	$52.48	$64.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.26 / $16.38 / $19.73	Professional	26	$13.26	$16.38	$19.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.47 / $36.57 / $44.81	Professional	TC	$30.47	$36.57	$44.81
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $23.73 / $35.65 / $47.67	Facility	26	$23.73	$35.65	$47.67
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $35.27 / $36.08 / $71.37	Facility	TC	$35.27	$36.08	$71.37
Medcost Facility/Professional Professional Modifier Low / Median / High Price $23.00 / $52.00 / $82.00	Professional		$23.00	$52.00	$82.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $21.07 / $50.81 / $93.81	Professional		$21.07	$50.81	$93.81
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $16.46 / $21.56 / $34.04	Professional	26	$16.46	$21.56	$34.04
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $28.58 / $40.17 / $65.94	Professional	TC	$28.58	$40.17	$65.94
United Facility/Professional Professional Modifier Low / Median / High Price $35.63 / $54.12 / $83.69	Professional		$35.63	$54.12	$83.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.39 / $19.42 / $30.13	Professional	26	$12.39	$19.42	$30.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.58 / $34.29 / $57.62	Professional	TC	$22.58	$34.29	$57.62