Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.34 / $12.41 / $48.89	Facility	26	$11.34	$12.41	$48.89
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.38 / $65.88 / $258.45	Facility	TC	$23.38	$65.88	$258.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.60 / $38.09 / $63.73	Professional		$31.60	$38.09	$63.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.53 / $12.41 / $21.19	Professional	26	$10.53	$12.41	$21.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.06 / $26.27 / $42.53	Professional	TC	$21.06	$26.27	$42.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.70 / $49.46 / $73.38	Professional		$35.70	$49.46	$73.38
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.42 / $14.57 / $22.29	Professional	26	$11.42	$14.57	$22.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.47 / $34.81 / $51.76	Professional	TC	$23.47	$34.81	$51.76
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $46.55 / $48.82 / $115.62	Professional		$46.55	$48.82	$115.62
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $15.25 / $15.40 / $19.55	Professional	26	$15.25	$15.40	$19.55
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $31.15 / $31.15 / $38.94	Professional	TC	$31.15	$31.15	$38.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $33.92 / $33.92 / $33.92	Facility	TC	$33.92	$33.92	$33.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.29 / $50.73 / $88.92	Professional		$33.29	$50.73	$88.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.33 / $16.92 / $28.36	Professional	26	$10.33	$16.92	$28.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.13 / $32.44 / $62.40	Professional	TC	$23.13	$32.44	$62.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.94 / $49.12 / $60.20	Professional		$40.94	$49.12	$60.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.44 / $14.13 / $17.03	Professional	26	$11.44	$14.13	$17.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.49 / $35.38 / $43.36	Professional	TC	$29.49	$35.38	$43.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $20.00 / $30.69 / $39.44	Facility	26	$20.00	$30.69	$39.44
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $34.77 / $35.56 / $69.06	Facility	TC	$34.77	$35.56	$69.06
Medcost Facility/Professional Professional Modifier Low / Median / High Price $19.00 / $48.70 / $76.00	Professional		$19.00	$48.70	$76.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $18.25 / $47.31 / $91.99	Professional		$18.25	$47.31	$91.99
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $13.93 / $18.25 / $28.73	Professional	26	$13.93	$18.25	$28.73
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $28.20 / $39.60 / $63.84	Professional	TC	$28.20	$39.60	$63.84
United Facility/Professional Professional Modifier Low / Median / High Price $32.86 / $50.24 / $77.40	Professional		$32.86	$50.24	$77.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.56 / $16.38 / $26.40	Professional	26	$10.56	$16.38	$26.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.57 / $33.86 / $51.21	Professional	TC	$20.57	$33.86	$51.21