Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $59.11 / $243.39 / $583.70	Facility		$59.11	$243.39	$583.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.59 / $16.30 / $30.32	Facility	26	$9.59	$16.30	$30.32
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.64 / $380.93 / $532.91	Facility	TC	$28.64	$380.93	$532.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.57 / $38.22 / $67.12	Professional		$32.57	$38.22	$67.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.23 / $10.75 / $22.81	Professional	26	$9.23	$10.75	$22.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.42 / $28.39 / $49.42	Professional	TC	$22.42	$28.39	$49.42
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $121.21 / $152.87 / $199.99	Facility		$121.21	$152.87	$199.99
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.65 / $44.52 / $64.94	Professional		$33.65	$44.52	$64.94
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.61 / $12.24 / $18.46	Professional	26	$9.61	$12.24	$18.46
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.35 / $32.47 / $47.47	Professional	TC	$24.35	$32.47	$47.47
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $44.20 / $44.20 / $105.81	Professional		$44.20	$44.20	$105.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $11.41 / $12.68 / $16.10	Professional	26	$11.41	$12.68	$16.10
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $28.37 / $31.52 / $40.03	Professional	TC	$28.37	$31.52	$40.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $69.29 / $111.11 / $500.00	Facility		$69.29	$111.11	$500.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.62 / $45.82 / $81.18	Professional		$30.62	$45.82	$81.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $13.95 / $23.97	Professional	26	$8.66	$13.95	$23.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.99 / $31.15 / $59.16	Professional	TC	$21.99	$31.15	$59.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.17 / $45.81 / $56.14	Professional		$38.17	$45.81	$56.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.66 / $11.94 / $14.39	Professional	26	$9.66	$11.94	$14.39
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $34.21 / $41.93	Professional	TC	$28.51	$34.21	$41.93
Medcost Facility/Professional Facility Modifier Low / Median / High Price $33.10 / $51.78 / $73.90	Facility		$33.10	$51.78	$73.90
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $16.02 / $18.00 / $33.13	Facility	26	$16.02	$18.00	$33.13
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $32.45 / $53.50 / $74.06	Facility	TC	$32.45	$53.50	$74.06
Medcost Facility/Professional Professional Modifier Low / Median / High Price $14.70 / $35.54 / $67.00	Professional		$14.70	$35.54	$67.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $13.39 / $35.79 / $71.05	Facility		$13.39	$35.79	$71.05
Sentara Facility/Professional Professional Modifier Low / Median / High Price $15.08 / $45.43 / $86.77	Professional		$15.08	$45.43	$86.77
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $11.12 / $15.27 / $24.18	Professional	26	$11.12	$15.27	$24.18
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $27.62 / $37.58 / $60.74	Professional	TC	$27.62	$37.58	$60.74
United Facility/Professional Facility Modifier Low / Median / High Price $35.76 / $185.87 / $185.87	Facility		$35.76	$185.87	$185.87
United Facility/Professional Professional Modifier Low / Median / High Price $30.24 / $45.94 / $69.52	Professional		$30.24	$45.94	$69.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $12.80 / $21.40	Professional	26	$8.64	$12.80	$21.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $31.07 / $50.23	Professional	TC	$20.96	$31.07	$50.23