Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.03 / $9.03 / $17.69	Facility	26	$6.03	$9.03	$17.69
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.87 / $287.92 / $575.85	Facility	TC	$24.87	$287.92	$575.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.47 / $34.14 / $63.00	Professional		$24.47	$34.14	$63.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.80 / $6.56 / $17.19	Professional	26	$5.80	$6.56	$17.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $21.77 / $21.77 / $21.77	Professional	50	$21.77	$21.77	$21.77
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.57 / $16.30 / $19.01	Professional	52	$12.57	$16.30	$19.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $28.85 / $52.59	Professional	TC	$22.57	$28.85	$52.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.50 / $42.94 / $62.76	Professional		$30.50	$42.94	$62.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $5.68 / $7.50 / $11.09	Professional	26	$5.68	$7.50	$11.09
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $45.55 / $64.54 / $94.14	Professional	50	$45.55	$64.54	$94.14
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.84 / $35.47 / $51.53	Professional	TC	$23.84	$35.47	$51.53
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $37.86 / $42.52 / $75.98	Professional		$37.86	$42.52	$75.98
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $6.93 / $7.47 / $9.49	Professional	26	$6.93	$7.47	$9.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $30.39 / $31.50 / $39.38	Professional	TC	$30.39	$31.50	$39.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.66 / $7.66 / $7.66	Facility	26	$7.66	$7.66	$7.66
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Facility	TC	$35.40	$35.40	$35.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.61 / $38.04 / $76.29	Professional		$25.61	$38.04	$76.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.35 / $8.69 / $15.02	Professional	26	$5.35	$8.69	$15.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.55 / $30.12 / $63.19	Professional	TC	$19.55	$30.12	$63.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.20 / $44.64 / $54.70	Professional		$37.20	$44.64	$54.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $6.07 / $7.50 / $9.05	Professional	26	$6.07	$7.50	$9.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.13 / $37.35 / $45.78	Professional	TC	$31.13	$37.35	$45.78
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $9.56 / $11.00 / $20.59	Facility	26	$9.56	$11.00	$20.59
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $27.57 / $46.14 / $79.03	Facility	TC	$27.57	$46.14	$79.03
Medcost Facility/Professional Professional Modifier Low / Median / High Price $9.00 / $34.00 / $58.00	Professional		$9.00	$34.00	$58.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $8.97 / $38.18 / $82.03	Professional		$8.97	$38.18	$82.03
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $9.35 / $15.09	Professional	26	$6.76	$9.35	$15.09
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $25.73 / $39.77 / $66.42	Professional	TC	$25.73	$39.77	$66.42
United Facility/Professional Professional Modifier Low / Median / High Price $24.23 / $37.81 / $66.52	Professional		$24.23	$37.81	$66.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.36 / $8.15 / $13.00	Professional	26	$5.36	$8.15	$13.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.27 / $28.58 / $51.23	Professional	TC	$16.27	$28.58	$51.23