Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $48.98 / $120.23	Facility	26	$28.84	$48.98	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $91.20 / $323.59	Professional		$48.98	$91.20	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $43.65 / $123.03	Professional	26	$25.12	$43.65	$123.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $25.12 / $102.33	Professional	TC	$10.00	$25.12	$102.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $75.86 / $112.20	Professional		$53.70	$75.86	$112.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $56.23 / $79.43	Professional	26	$33.88	$56.23	$79.43
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $79.43 / $112.20 / $165.96	Professional	50	$79.43	$112.20	$165.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $15.85 / $38.02	Professional	TC	$10.96	$15.85	$38.02
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $12.30 / $57.54 / $263.03	Professional		$12.30	$57.54	$263.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $45.71 / $51.29	Professional	26	$40.74	$45.71	$51.29
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $11.22 / $19.50	Professional	TC	$11.22	$11.22	$19.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $69.18	Facility	26	$10.47	$48.98	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $114.82 / $181.97	Professional		$45.71	$114.82	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $38.90 / $79.43	Professional	26	$26.92	$38.90	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $9.77 / $74.13 / $128.82	Professional	TC	$9.77	$74.13	$128.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $60.26 / $74.13	Professional		$47.86	$60.26	$74.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $46.77 / $58.88	Professional	26	$37.15	$46.77	$58.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $12.88 / $16.22	Professional	TC	$10.47	$12.88	$16.22
Medcost Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $177.83 / $208.93	Professional		$165.96	$177.83	$208.93
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $54.95 / $56.23	Professional	26	$43.65	$54.95	$56.23
Medcost Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $91.20 / $95.50	Professional		$91.20	$91.20	$95.50
Sentara Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $104.71 / $229.09	Professional		$35.48	$104.71	$229.09
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $41.69 / $67.61	Professional	26	$30.90	$41.69	$67.61
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $83.18 / $134.90	Professional	TC	$15.14	$83.18	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $109.65 / $186.21	Professional		$61.66	$109.65	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $34.67 / $54.95	Professional	26	$22.91	$34.67	$54.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $74.13 / $138.04	Professional	TC	$36.31	$74.13	$138.04