Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $12.02 / $16.60	Facility	26	$7.94	$12.02	$16.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $63.10 / $125.89	Professional		$50.12	$63.10	$125.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.55 / $27.54	Professional	26	$7.94	$9.55	$27.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $8.13 / $8.32 / $39.81	Professional	52	$8.13	$8.32	$39.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $51.29 / $95.50	Professional	TC	$42.66	$51.29	$95.50
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $72.44 / $109.65	Professional		$53.70	$72.44	$109.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $11.22 / $16.98	Professional	26	$8.32	$11.22	$16.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $61.66 / $93.33	Professional	TC	$45.71	$61.66	$93.33
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $74.13 / $295.12	Professional		$16.22	$74.13	$295.12
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $10.47 / $13.49	Professional	26	$9.55	$10.47	$13.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $63.10 / $79.43	Professional	TC	$56.23	$63.10	$79.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $72.44 / $120.23	Professional		$54.95	$72.44	$120.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $10.96 / $17.78	Professional	26	$8.71	$10.96	$17.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $60.26 / $102.33	Professional	TC	$45.71	$60.26	$102.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $74.13 / $95.50	Professional		$58.88	$74.13	$95.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $10.23 / $15.49	Professional	26	$8.13	$10.23	$15.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $63.10 / $81.28	Professional	TC	$51.29	$63.10	$81.28
Medcost Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $112.20 / $112.20	Professional		$77.62	$112.20	$112.20
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $16.22 / $16.22	Professional	26	$13.49	$16.22	$16.22
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $64.57 / $64.57	Professional	TC	$64.57	$64.57	$64.57
Medcost Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $40.74 / $40.74	Professional		$40.74	$40.74	$40.74
Sentara Facility/Professional Professional Modifier Low / Median / High Price $10.47 / $60.26 / $104.71	Professional		$10.47	$60.26	$104.71
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $10.47 / $16.98	Professional	26	$8.71	$10.47	$16.98
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $57.54 / $95.50	Professional	TC	$45.71	$57.54	$95.50
United Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $69.18 / $109.65	Professional		$45.71	$69.18	$109.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.23 / $16.60	Professional	26	$7.08	$10.23	$16.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $57.54 / $93.33	Professional	TC	$38.90	$57.54	$93.33