Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $16.98 / $42.66	Facility	26	$10.00	$16.98	$42.66
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.11 / $346.74 / $794.33	Facility	TC	$33.11	$346.74	$794.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $47.86 / $141.25	Professional		$16.60	$47.86	$141.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $21.88 / $60.26	Professional	26	$10.00	$21.88	$60.26
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $39.81 / $95.50 / $239.88	Professional	50	$39.81	$95.50	$239.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	52	$43.65	$43.65	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $43.65 / $93.33	Professional	TC	$28.18	$43.65	$93.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $58.88 / $93.33	Professional		$41.69	$58.88	$93.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $14.13 / $21.88	Professional	26	$10.23	$14.13	$21.88
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $63.10 / $91.20 / $141.25	Professional	50	$63.10	$91.20	$141.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $45.71 / $70.79	Professional	TC	$30.90	$45.71	$70.79
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $53.70 / $120.23	Professional		$32.36	$53.70	$120.23
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $11.75 / $16.60	Professional	26	$10.47	$11.75	$16.60
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $38.02 / $64.57	Professional	TC	$24.55	$38.02	$64.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.69 / $12.59 / $17.78	Facility	26	$2.69	$12.59	$17.78
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	TC	$8.51	$39.81	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $50.12 / $95.50	Professional		$34.67	$50.12	$95.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $13.80 / $23.99	Professional	26	$8.71	$13.80	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $35.48 / $74.13	Professional	TC	$25.12	$35.48	$74.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $58.88 / $72.44	Professional		$48.98	$58.88	$72.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $12.59 / $16.22	Professional	26	$10.23	$12.59	$16.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $45.71 / $56.23	Professional	TC	$38.02	$45.71	$56.23
Medcost Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $56.23 / $100.00	Professional		$45.71	$56.23	$100.00
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $19.05 / $23.44	Professional	26	$15.49	$19.05	$23.44
Medcost Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $34.67 / $75.86	Professional		$34.67	$34.67	$75.86
Sentara Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $46.77 / $181.97	Professional		$14.13	$46.77	$181.97
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $14.45 / $23.99	Professional	26	$10.96	$14.45	$23.99
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $41.69 / $75.86	Professional	TC	$27.54	$41.69	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $47.86 / $85.11	Professional		$29.51	$47.86	$85.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $12.59 / $21.88	Professional	26	$8.51	$12.59	$21.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $33.88 / $63.10	Professional	TC	$21.88	$33.88	$63.10