Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.67 / $12.72 / $46.22	Facility	26	$11.67	$12.72	$46.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.86 / $52.77 / $102.70	Professional		$40.86	$52.77	$102.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.97 / $12.72 / $23.06	Professional	26	$10.97	$12.72	$23.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.18 / $40.33 / $79.16	Professional	TC	$30.18	$40.33	$79.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.55 / $68.86 / $102.39	Professional		$50.55	$68.86	$102.39
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.72 / $15.06 / $22.99	Professional	26	$11.72	$15.06	$22.99
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $75.58 / $101.03 / $155.19	Professional	50	$75.58	$101.03	$155.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.46 / $53.94 / $78.77	Professional	TC	$39.46	$53.94	$78.77
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $56.91 / $67.70 / $121.68	Professional		$56.91	$67.70	$121.68
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $15.68 / $16.26 / $20.65	Professional	26	$15.68	$16.26	$20.65
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $40.65 / $46.90 / $58.62	Professional	TC	$40.65	$46.90	$58.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.00 / $15.00 / $15.00	Facility	26	$15.00	$15.00	$15.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.44 / $67.28 / $121.16	Professional		$45.44	$67.28	$121.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.58 / $17.53 / $29.35	Professional	26	$10.58	$17.53	$29.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.10 / $48.25 / $93.46	Professional	TC	$35.10	$48.25	$93.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.62 / $70.34 / $86.15	Professional		$58.62	$70.34	$86.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.10 / $14.94 / $17.52	Professional	26	$12.10	$14.94	$17.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.53 / $55.83 / $68.43	Professional	TC	$46.53	$55.83	$68.43
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $21.32 / $21.32 / $41.21	Facility	26	$21.32	$21.32	$41.21
Medcost Facility/Professional Professional Modifier Low / Median / High Price $18.00 / $52.00 / $104.48	Professional		$18.00	$52.00	$104.48
Sentara Facility/Professional Professional Modifier Low / Median / High Price $18.96 / $61.75 / $112.09	Professional		$18.96	$61.75	$112.09
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $14.49 / $18.86 / $29.49	Professional	26	$14.49	$18.86	$29.49
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $40.94 / $57.50 / $96.08	Professional	TC	$40.94	$57.50	$96.08
United Facility/Professional Professional Modifier Low / Median / High Price $44.94 / $67.40 / $103.06	Professional		$44.94	$67.40	$103.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.06 / $16.80 / $28.23	Professional	26	$11.06	$16.80	$28.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.93 / $50.60 / $79.76	Professional	TC	$32.93	$50.60	$79.76