Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $17.38 / $42.66	Facility	26	$9.55	$17.38	$42.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $45.71 / $128.82	Professional		$30.90	$45.71	$128.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.45 / $33.11	Professional	26	$8.91	$14.45	$33.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $32.36 / $64.57	Professional	TC	$22.91	$32.36	$64.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $52.48 / $79.43	Professional		$38.02	$52.48	$79.43
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $13.80 / $20.89	Professional	26	$10.23	$13.80	$20.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $39.81 / $60.26	Professional	TC	$28.18	$39.81	$60.26
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $47.86 / $165.96	Professional		$38.90	$47.86	$165.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $11.48 / $15.85	Professional	26	$10.23	$11.48	$15.85
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $34.67 / $48.98	Professional	TC	$30.90	$34.67	$48.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $53.70 / $89.13	Professional		$32.36	$53.70	$89.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $13.49 / $23.44	Professional	26	$8.71	$13.49	$23.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $40.74 / $67.61	Professional	TC	$23.99	$40.74	$67.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $50.12 / $61.66	Professional		$41.69	$50.12	$61.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $12.30 / $15.49	Professional	26	$10.00	$12.30	$15.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $38.02 / $45.71	Professional	TC	$30.90	$38.02	$45.71
Medcost Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $72.44 / $89.13	Professional		$58.88	$72.44	$89.13
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $19.05 / $23.44	Professional	26	$15.49	$19.05	$23.44
Medcost Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $47.86 / $66.07	Professional		$47.86	$47.86	$66.07
Sentara Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $47.86 / $169.82	Professional		$14.13	$47.86	$169.82
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $14.45 / $24.55	Professional	26	$10.96	$14.45	$24.55
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $40.74 / $66.07	Professional	TC	$30.20	$40.74	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $47.86 / $83.18	Professional		$31.62	$47.86	$83.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $12.59 / $22.39	Professional	26	$8.51	$12.59	$22.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $34.67 / $61.66	Professional	TC	$22.39	$34.67	$61.66