Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.18 / $19.18 / $54.02	Facility	26	$19.18	$19.18	$54.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $38.19 / $102.89	Professional		$32.34	$38.19	$102.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.89 / $21.85 / $40.35	Professional	26	$17.89	$21.85	$40.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.17 / $17.39 / $43.18	Professional	TC	$14.17	$17.39	$43.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.17 / $45.98 / $95.95	Professional		$35.17	$45.98	$95.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $24.76 / $37.13	Professional	26	$18.48	$24.76	$37.13
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $52.76 / $68.97 / $114.02	Professional	50	$52.76	$68.97	$114.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.23 / $21.22 / $40.34	Professional	TC	$16.23	$21.22	$40.34
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $39.32 / $39.32 / $419.85	Professional		$39.32	$39.32	$419.85
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $19.36 / $21.51 / $27.32	Professional	26	$19.36	$21.51	$27.32
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $17.80 / $17.80 / $52.98	Professional	TC	$17.80	$17.80	$52.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.05 / $24.05 / $24.05	Facility	26	$24.05	$24.05	$24.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.22 / $59.93 / $175.00	Professional		$35.22	$59.93	$175.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.04 / $32.68 / $58.86	Professional	26	$20.04	$32.68	$58.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.78 / $26.87 / $129.88	Professional	TC	$15.78	$26.87	$129.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $36.52 / $44.41 / $54.71	Professional		$36.52	$44.41	$54.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.16 / $23.67 / $28.54	Professional	26	$19.16	$23.67	$28.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $17.37 / $20.84 / $25.54	Professional	TC	$17.37	$20.84	$25.54
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $25.20 / $35.97 / $58.43	Facility	26	$25.20	$35.97	$58.43
Medcost Facility/Professional Professional Modifier Low / Median / High Price $22.49 / $48.00 / $144.00	Professional		$22.49	$48.00	$144.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $29.04 / $73.26 / $180.22	Professional		$29.04	$73.26	$180.22
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $23.34 / $38.31 / $53.16	Professional	26	$23.34	$38.31	$53.16
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $18.69 / $34.96 / $132.65	Professional	TC	$18.69	$34.96	$132.65
United Facility/Professional Professional Modifier Low / Median / High Price $34.52 / $57.34 / $192.23	Professional		$34.52	$57.34	$192.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.19 / $29.42 / $47.65	Professional	26	$19.19	$29.42	$47.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.54 / $23.49 / $126.87	Professional	TC	$15.54	$23.49	$126.87