Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $16.22 / $22.39	Facility	26	$10.00	$16.22	$22.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $60.26 / $120.23	Professional		$48.98	$60.26	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.22 / $44.67	Professional	26	$10.96	$16.22	$44.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $45.71 / $81.28	Professional	TC	$38.02	$45.71	$81.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $72.44 / $109.65	Professional		$53.70	$72.44	$109.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $15.14 / $22.91	Professional	26	$11.22	$15.14	$22.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $56.23 / $85.11	Professional	TC	$42.66	$56.23	$85.11
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $74.13 / $112.20	Professional		$12.88	$74.13	$112.20
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $14.13 / $19.95	Professional	26	$14.13	$14.13	$19.95
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $60.26 / $77.62	Professional	TC	$53.70	$60.26	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $70.79 / $112.20	Professional		$53.70	$70.79	$112.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $15.14 / $24.55	Professional	26	$11.75	$15.14	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $54.95 / $91.20	Professional	TC	$41.69	$54.95	$91.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $74.13 / $95.50	Professional		$58.88	$74.13	$95.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $13.18 / $19.95	Professional	26	$10.47	$13.18	$19.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $60.26 / $75.86	Professional	TC	$48.98	$60.26	$75.86
Medcost Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $102.33 / $102.33	Professional		$75.86	$102.33	$102.33
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $21.88 / $21.88	Professional	26	$17.78	$21.88	$21.88
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $57.54 / $57.54	Professional	TC	$57.54	$57.54	$57.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $79.43 / $79.43	Professional		$79.43	$79.43	$79.43
Sentara Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $58.88 / $109.65	Professional		$15.14	$58.88	$109.65
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $14.79 / $22.91	Professional	26	$11.75	$14.79	$22.91
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $52.48 / $83.18	Professional	TC	$41.69	$52.48	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $66.07 / $104.71	Professional		$44.67	$66.07	$104.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.45 / $22.39	Professional	26	$10.00	$14.45	$22.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $51.29 / $83.18	Professional	TC	$34.67	$51.29	$83.18