Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $22.92 / $52.50	Facility	26	$12.88	$22.92	$52.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.74 / $60.27 / $105.76	Professional		$50.74	$60.27	$105.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.43 / $16.55 / $33.70	Professional	26	$12.43	$16.55	$33.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.97 / $44.99 / $80.56	Professional	TC	$36.97	$44.99	$80.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.51 / $70.34 / $108.05	Professional		$56.51	$70.34	$108.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.92 / $16.89 / $25.31	Professional	26	$12.92	$16.89	$25.31
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.54 / $54.25 / $79.13	Professional	TC	$40.54	$54.25	$79.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $74.39 / $75.26 / $191.05	Professional		$74.39	$75.26	$191.05
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $18.84 / $19.72 / $25.04	Professional	26	$18.84	$19.72	$25.04
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $49.99 / $55.55 / $70.55	Professional	TC	$49.99	$55.55	$70.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.84 / $78.20 / $132.13	Professional		$48.84	$78.20	$132.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $20.83 / $36.71	Professional	26	$11.77	$20.83	$36.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.90 / $56.08 / $97.99	Professional	TC	$36.90	$56.08	$97.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $59.82 / $71.79 / $87.98	Professional		$59.82	$71.79	$87.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.96 / $16.01 / $19.32	Professional	26	$12.96	$16.01	$19.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.86 / $56.23 / $68.91	Professional	TC	$46.86	$56.23	$68.91
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $25.86 / $30.00 / $51.75	Facility	26	$25.86	$30.00	$51.75
Medcost Facility/Professional Professional Modifier Low / Median / High Price $23.00 / $64.00 / $108.00	Professional		$23.00	$64.00	$108.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $24.12 / $76.70 / $136.63	Professional		$24.12	$76.70	$136.63
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $16.21 / $22.19 / $33.29	Professional	26	$16.21	$22.19	$33.29
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $48.23 / $65.81 / $102.97	Professional	TC	$48.23	$65.81	$102.97
United Facility/Professional Professional Modifier Low / Median / High Price $47.21 / $71.70 / $113.79	Professional		$47.21	$71.70	$113.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.03 / $18.53 / $31.13	Professional	26	$12.03	$18.53	$31.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.46 / $53.18 / $83.81	Professional	TC	$35.46	$53.18	$83.81