Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $17.95 / $40.72	Facility	26	$12.59	$17.95	$40.72
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.97 / $116.45 / $442.80	Facility	TC	$30.97	$116.45	$442.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.14 / $48.88 / $91.77	Professional		$44.14	$48.88	$91.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.96 / $13.68 / $27.61	Professional	26	$11.96	$13.68	$27.61
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.84 / $29.84 / $29.84	Professional	50	$29.84	$29.84	$29.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.85 / $35.57 / $68.23	Professional	TC	$30.85	$35.57	$68.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.99 / $61.98 / $92.14	Professional		$45.99	$61.98	$92.14
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.63 / $16.22 / $24.76	Professional	26	$12.63	$16.22	$24.76
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $68.98 / $90.92 / $139.68	Professional	50	$68.98	$90.92	$139.68
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.78 / $45.91 / $68.25	Professional	TC	$33.78	$45.91	$68.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $53.60 / $61.16 / $120.48	Professional		$53.60	$61.16	$120.48
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $16.89 / $17.02 / $21.62	Professional	26	$16.89	$17.02	$21.62
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $36.58 / $40.39 / $50.49	Professional	TC	$36.58	$40.39	$50.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.14 / $16.14 / $16.14	Facility	26	$16.14	$16.14	$16.14
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $44.74 / $44.74 / $44.74	Facility	TC	$44.74	$44.74	$44.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.61 / $63.63 / $110.83	Professional		$41.61	$63.63	$110.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.40 / $18.70 / $31.44	Professional	26	$11.40	$18.70	$31.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.27 / $43.59 / $81.19	Professional	TC	$30.27	$43.59	$81.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $52.00 / $62.40 / $76.48	Professional		$52.00	$62.40	$76.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.68 / $15.67 / $18.84	Professional	26	$12.68	$15.67	$18.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.32 / $47.19 / $57.83	Professional	TC	$39.32	$47.19	$57.83
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $25.63 / $39.70 / $51.77	Facility	26	$25.63	$39.70	$51.77
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $44.41 / $46.86 / $102.78	Facility	TC	$44.41	$46.86	$102.78
Medcost Facility/Professional Professional Modifier Low / Median / High Price $19.00 / $47.00 / $94.15	Professional		$19.00	$47.00	$94.15
Sentara Facility/Professional Professional Modifier Low / Median / High Price $19.92 / $58.36 / $109.51	Professional		$19.92	$58.36	$109.51
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $15.20 / $20.12 / $31.75	Professional	26	$15.20	$20.12	$31.75
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $36.99 / $51.56 / $82.77	Professional	TC	$36.99	$51.56	$82.77
United Facility/Professional Professional Modifier Low / Median / High Price $39.19 / $62.70 / $102.63	Professional		$39.19	$62.70	$102.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.53 / $18.10 / $30.41	Professional	26	$11.53	$18.10	$30.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.03 / $43.91 / $70.30	Professional	TC	$29.03	$43.91	$70.30