Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.67 / $43.20 / $85.33	Facility	26	$28.67	$43.20	$85.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.16 / $79.56 / $167.55	Professional		$49.16	$79.56	$167.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $31.75 / $66.53	Professional	26	$24.78	$31.75	$66.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.87 / $50.89 / $112.13	Professional	TC	$10.87	$50.89	$112.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.47 / $63.27 / $103.11	Professional		$49.47	$63.27	$103.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.94 / $47.93 / $68.98	Professional	26	$33.94	$47.93	$68.98
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $74.20 / $94.63 / $142.24	Professional	50	$74.20	$94.63	$142.24
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $10.14 / $12.97 / $27.06	Professional	TC	$10.14	$12.97	$27.06
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $59.15 / $82.64 / $288.92	Professional		$59.15	$82.64	$288.92
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $35.35 / $35.35 / $66.81	Professional	26	$35.35	$35.35	$66.81
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $15.71 / $47.29 / $92.22	Professional	TC	$15.71	$47.29	$92.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.32 / $49.32 / $49.32	Facility	26	$49.32	$49.32	$49.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.94 / $116.70 / $185.04	Professional		$44.94	$116.70	$185.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.26 / $39.61 / $78.55	Professional	26	$27.26	$39.61	$78.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $9.81 / $77.25 / $126.46	Professional	TC	$9.81	$77.25	$126.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $49.06 / $61.30 / $75.59	Professional		$49.06	$61.30	$75.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.58 / $49.02 / $60.64	Professional	26	$38.58	$49.02	$60.64
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $10.11 / $12.94 / $16.30	Professional	TC	$10.11	$12.94	$16.30
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $41.73 / $42.18 / $105.78	Facility	26	$41.73	$42.18	$105.78
Medcost Facility/Professional Professional Modifier Low / Median / High Price $39.00 / $107.00 / $176.51	Professional		$39.00	$107.00	$176.51
Sentara Facility/Professional Professional Modifier Low / Median / High Price $36.42 / $112.60 / $183.75	Professional		$36.42	$112.60	$183.75
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $31.54 / $43.03 / $67.29	Professional	26	$31.54	$43.03	$67.29
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $29.24 / $84.30 / $134.88	Professional	TC	$29.24	$84.30	$134.88
United Facility/Professional Professional Modifier Low / Median / High Price $62.74 / $108.82 / $180.74	Professional		$62.74	$108.82	$180.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.98 / $37.58 / $58.01	Professional	26	$22.98	$37.58	$58.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $75.73 / $132.22	Professional	TC	$37.15	$75.73	$132.22