Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.73 / $20.87 / $40.67	Facility	26	$11.73	$20.87	$40.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.57 / $40.01 / $75.16	Professional		$33.57	$40.01	$75.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.97 / $13.03 / $23.85	Professional	26	$10.97	$13.03	$23.85
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.28 / $19.75 / $22.83	Professional	52	$15.28	$19.75	$22.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.53 / $27.71 / $50.52	Professional	TC	$20.53	$27.71	$50.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.57 / $50.88 / $74.22	Professional		$39.57	$50.88	$74.22
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.72 / $15.06 / $21.70	Professional	26	$11.72	$15.06	$21.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.74 / $36.29 / $52.93	Professional	TC	$25.74	$36.29	$52.93
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $42.43 / $51.51 / $156.33	Professional		$42.43	$51.51	$156.33
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $14.99 / $16.07 / $20.41	Professional	26	$14.99	$16.07	$20.41
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $26.36 / $33.47 / $41.08	Professional	TC	$26.36	$33.47	$41.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.96 / $14.96 / $14.96	Facility	26	$14.96	$14.96	$14.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.82 / $51.14 / $92.86	Professional		$34.82	$51.14	$92.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.63 / $16.91 / $28.08	Professional	26	$10.63	$16.91	$28.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.06 / $32.44 / $66.04	Professional	TC	$23.06	$32.44	$66.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $43.59 / $52.31 / $64.09	Professional		$43.59	$52.31	$64.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.81 / $14.58 / $17.59	Professional	26	$11.81	$14.58	$17.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.78 / $38.14 / $46.74	Professional	TC	$31.78	$38.14	$46.74
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $15.20 / $23.64 / $43.20	Facility	26	$15.20	$23.64	$43.20
Medcost Facility/Professional Professional Modifier Low / Median / High Price $18.02 / $35.06 / $69.00	Professional		$18.02	$35.06	$69.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $19.01 / $51.10 / $99.56	Professional		$19.01	$51.10	$99.56
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $13.07 / $20.04 / $32.49	Professional	26	$13.07	$20.04	$32.49
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $26.78 / $44.95 / $70.16	Professional	TC	$26.78	$44.95	$70.16
United Facility/Professional Professional Modifier Low / Median / High Price $33.69 / $50.81 / $80.48	Professional		$33.69	$50.81	$80.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.93 / $16.77 / $28.67	Professional	26	$10.93	$16.77	$28.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.64 / $33.40 / $57.47	Professional	TC	$22.64	$33.40	$57.47