Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.14 / $10.25 / $18.14	Facility	26	$8.14	$10.25	$18.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.93 / $58.25 / $97.85	Professional		$51.93	$58.25	$97.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.46 / $9.08 / $16.73	Professional	26	$7.46	$9.08	$16.73
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.34 / $28.51 / $31.72	Professional	52	$24.34	$28.51	$31.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.57 / $48.48 / $81.20	Professional	TC	$43.57	$48.48	$81.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.43 / $66.31 / $92.93	Professional		$51.43	$66.31	$92.93
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.82 / $10.05 / $14.10	Professional	26	$7.82	$10.05	$14.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.70 / $56.18 / $79.23	Professional	TC	$43.70	$56.18	$79.23
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $75.73 / $75.73 / $155.25	Professional		$75.73	$75.73	$155.25
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $10.68 / $10.68 / $19.70	Professional	26	$10.68	$10.68	$19.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $65.05 / $65.05 / $120.03	Professional	TC	$65.05	$65.05	$120.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.06 / $10.06 / $10.06	Facility	26	$10.06	$10.06	$10.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.49 / $72.94 / $125.73	Professional		$55.49	$72.94	$125.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.67 / $11.21 / $18.39	Professional	26	$8.67	$11.21	$18.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.25 / $61.77 / $106.18	Professional	TC	$46.25	$61.77	$106.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.14 / $64.13 / $91.40	Professional		$51.14	$64.13	$91.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.35 / $9.65 / $13.79	Professional	26	$7.35	$9.65	$13.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $43.79 / $54.74 / $70.59	Professional	TC	$43.79	$54.74	$70.59
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $10.25 / $16.76 / $24.14	Facility	26	$10.25	$16.76	$24.14
Medcost Facility/Professional Professional Modifier Low / Median / High Price $12.00 / $64.00 / $101.97	Professional		$12.00	$64.00	$101.97
Sentara Facility/Professional Professional Modifier Low / Median / High Price $10.52 / $60.16 / $105.57	Professional		$10.52	$60.16	$105.57
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.96 / $10.79 / $17.34	Professional	26	$8.96	$10.79	$17.34
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $46.04 / $58.31 / $97.42	Professional	TC	$46.04	$58.31	$97.42
United Facility/Professional Professional Modifier Low / Median / High Price $45.49 / $67.55 / $105.60	Professional		$45.49	$67.55	$105.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.00 / $10.27 / $15.99	Professional	26	$7.00	$10.27	$15.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $57.03 / $90.71	Professional	TC	$38.02	$57.03	$90.71