Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.88 / $17.30 / $35.85	Facility	26	$9.88	$17.30	$35.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.60 / $40.39 / $75.30	Professional		$31.60	$40.39	$75.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $10.45 / $19.53	Professional	26	$8.61	$10.45	$19.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $30.06 / $56.38	Professional	TC	$22.57	$30.06	$56.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.28 / $50.14 / $77.02	Professional		$40.28	$50.14	$77.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.52 / $13.09 / $20.05	Professional	26	$10.52	$13.09	$20.05
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.76 / $37.04 / $56.90	Professional	TC	$29.76	$37.04	$56.90
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $48.40 / $48.76 / $144.10	Professional		$48.40	$48.76	$144.10
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $11.50 / $11.60 / $14.61	Professional	26	$11.50	$11.60	$14.61
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $36.89 / $36.89 / $46.85	Professional	TC	$36.89	$36.89	$46.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.50 / $13.50 / $13.50	Facility	26	$13.50	$13.50	$13.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.40 / $55.75 / $95.73	Professional		$35.40	$55.75	$95.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.05 / $14.04 / $25.13	Professional	26	$9.05	$14.04	$25.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.17 / $41.96 / $68.50	Professional	TC	$26.17	$41.96	$68.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.98 / $51.57 / $63.20	Professional		$42.98	$51.57	$63.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.54 / $13.02 / $15.68	Professional	26	$10.54	$13.02	$15.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.44 / $38.92 / $47.70	Professional	TC	$32.44	$38.92	$47.70
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $15.00 / $18.00 / $36.34	Facility	26	$15.00	$18.00	$36.34
Medcost Facility/Professional Professional Modifier Low / Median / High Price $14.00 / $47.00 / $77.64	Professional		$14.00	$47.00	$77.64
Sentara Facility/Professional Professional Modifier Low / Median / High Price $15.08 / $53.64 / $98.11	Professional		$15.08	$53.64	$98.11
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $11.34 / $16.01 / $26.47	Professional	26	$11.34	$16.01	$26.47
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $32.83 / $45.26 / $71.39	Professional	TC	$32.83	$45.26	$71.39
United Facility/Professional Professional Modifier Low / Median / High Price $34.63 / $51.95 / $87.28	Professional		$34.63	$51.95	$87.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.24 / $13.90 / $21.74	Professional	26	$9.24	$13.90	$21.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.57 / $36.86 / $65.09	Professional	TC	$24.57	$36.86	$65.09