Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $15.49 / $51.29	Facility	26	$10.96	$15.49	$51.29
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $53.70 / $87.10	Facility	TC	$28.84	$53.70	$87.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $41.69 / $100.00	Professional		$32.36	$41.69	$100.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $16.22 / $37.15	Professional	26	$10.23	$16.22	$37.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $28.18 / $58.88	Professional	TC	$20.89	$28.18	$58.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $56.23 / $85.11	Professional		$38.90	$56.23	$85.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $16.60 / $25.12	Professional	26	$11.75	$16.60	$25.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $39.81 / $60.26	Professional	TC	$26.92	$39.81	$60.26
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $47.86 / $117.49	Professional		$30.90	$47.86	$117.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $13.49 / $19.05	Professional	26	$12.02	$13.49	$19.05
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $48.98 / $52.48	Professional	TC	$38.90	$48.98	$52.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.09 / $14.45 / $20.89	Facility	26	$3.09	$14.45	$20.89
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.92 / $32.36 / $46.77	Facility	TC	$6.92	$32.36	$46.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $50.12 / $89.13	Professional		$33.11	$50.12	$89.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $16.22 / $28.18	Professional	26	$10.00	$16.22	$28.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $31.62 / $63.10	Professional	TC	$22.39	$31.62	$63.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $50.12 / $61.66	Professional		$40.74	$50.12	$61.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $14.13 / $16.98	Professional	26	$11.48	$14.13	$16.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $35.48 / $43.65	Professional	TC	$28.84	$35.48	$43.65
Medcost Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $27.54 / $27.54	Professional	26	$27.54	$27.54	$27.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $15.85 / $70.79	Professional		$15.85	$15.85	$70.79
Sentara Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $44.67 / $138.04	Professional		$16.60	$44.67	$138.04
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.98 / $28.84	Professional	26	$13.18	$16.98	$28.84
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $34.67 / $64.57	Professional	TC	$25.12	$34.67	$64.57
United Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $46.77 / $79.43	Professional		$30.90	$46.77	$79.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.14 / $26.92	Professional	26	$10.00	$15.14	$26.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $30.90 / $53.70	Professional	TC	$20.42	$30.90	$53.70