Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.28 / $36.49 / $66.42	Facility	26	$22.28	$36.49	$66.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.64 / $51.35 / $95.11	Professional		$28.64	$51.35	$95.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.60 / $29.32 / $54.22	Professional	26	$18.60	$29.32	$54.22
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.33 / $69.77 / $69.90	Professional	50	$33.33	$69.77	$69.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.18 / $26.75 / $47.34	Professional	TC	$9.18	$26.75	$47.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.52 / $71.09 / $102.40	Professional		$51.52	$71.09	$102.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.72 / $36.36 / $52.28	Professional	26	$25.72	$36.36	$52.28
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $83.72 / $108.65 / $153.61	Professional	50	$83.72	$108.65	$153.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.21 / $34.79 / $50.12	Professional	TC	$25.21	$34.79	$50.12
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $63.05 / $70.05 / $288.92	Professional		$63.05	$70.05	$288.92
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $25.97 / $25.97 / $49.08	Professional	26	$25.97	$25.97	$49.08
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $33.45 / $37.17 / $70.25	Professional	TC	$33.45	$37.17	$70.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.43 / $37.43 / $37.43	Facility	26	$37.43	$37.43	$37.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.10 / $52.70 / $124.48	Professional		$33.10	$52.70	$124.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.76 / $28.36 / $60.86	Professional	26	$20.76	$28.36	$60.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.81 / $22.62 / $67.69	Professional	TC	$10.81	$22.62	$67.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.02 / $73.75 / $90.96	Professional		$58.02	$73.75	$90.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.53 / $37.52 / $46.32	Professional	26	$29.53	$37.52	$46.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.30 / $37.35 / $44.64	Professional	TC	$29.30	$37.35	$44.64
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $28.91 / $29.25 / $76.56	Facility	26	$28.91	$29.25	$76.56
Medcost Facility/Professional Professional Modifier Low / Median / High Price $14.00 / $40.01 / $78.00	Professional		$14.00	$40.01	$78.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $14.37 / $40.39 / $124.57	Professional		$14.37	$40.39	$124.57
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $23.15 / $32.29 / $51.39	Professional	26	$23.15	$32.29	$51.39
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $11.21 / $32.86 / $69.45	Professional	TC	$11.21	$32.86	$69.45
United Facility/Professional Professional Modifier Low / Median / High Price $28.68 / $53.01 / $96.75	Professional		$28.68	$53.01	$96.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.23 / $27.39 / $42.76	Professional	26	$16.23	$27.39	$42.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $9.78 / $26.30 / $56.37	Professional	TC	$9.78	$26.30	$56.37