Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.59 / $213.60 / $555.00	Facility		$47.59	$213.60	$555.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.69 / $13.99 / $29.06	Facility	26	$8.69	$13.99	$29.06
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.03 / $266.32 / $434.16	Facility	TC	$23.03	$266.32	$434.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.98 / $31.73 / $60.39	Professional		$26.98	$31.73	$60.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.46 / $10.19 / $21.00	Professional	26	$8.46	$10.19	$21.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.69 / $23.04 / $41.01	Professional	TC	$18.69	$23.04	$41.01
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $100.67 / $126.96 / $166.10	Facility		$100.67	$126.96	$166.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.76 / $37.04 / $57.11	Professional		$29.76	$37.04	$57.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.72 / $11.40 / $16.89	Professional	26	$8.72	$11.40	$16.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $26.13 / $40.38	Professional	TC	$20.96	$26.13	$40.38
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $36.44 / $36.69 / $111.69	Professional		$36.44	$36.69	$111.69
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $11.60 / $11.91 / $15.13	Professional	26	$11.60	$11.91	$15.13
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $24.78 / $24.78 / $31.47	Professional	TC	$24.78	$24.78	$31.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $56.18 / $93.71 / $500.00	Facility		$56.18	$93.71	$500.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.16 / $11.16 / $11.16	Facility	26	$11.16	$11.16	$11.16
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $26.10 / $26.10	Facility	TC	$26.10	$26.10	$26.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.25 / $43.61 / $71.95	Professional		$26.25	$43.61	$71.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $13.25 / $23.45	Professional	26	$7.95	$13.25	$23.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.52 / $29.50 / $50.87	Professional	TC	$18.52	$29.50	$50.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $31.69 / $38.03 / $46.60	Professional		$31.69	$38.03	$46.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.76 / $10.82 / $13.04	Professional	26	$8.76	$10.82	$13.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.93 / $27.52 / $33.72	Professional	TC	$22.93	$27.52	$33.72
Medcost Facility/Professional Facility Modifier Low / Median / High Price $30.41 / $46.13 / $71.31	Facility		$30.41	$46.13	$71.31
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $15.93 / $18.00 / $32.25	Facility	26	$15.93	$18.00	$32.25
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $37.61 / $72.98	Facility	TC	$26.10	$37.61	$72.98
Medcost Facility/Professional Professional Modifier Low / Median / High Price $14.00 / $33.00 / $55.00	Professional		$14.00	$33.00	$55.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $12.61 / $31.72 / $59.17	Facility		$12.61	$31.72	$59.17
Sentara Facility/Professional Professional Modifier Low / Median / High Price $14.70 / $39.71 / $73.81	Professional		$14.70	$39.71	$73.81
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $10.83 / $14.45 / $21.92	Professional	26	$10.83	$14.45	$21.92
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $23.43 / $31.50 / $49.78	Professional	TC	$23.43	$31.50	$49.78
United Facility/Professional Professional Modifier Low / Median / High Price $25.46 / $38.20 / $64.18	Professional		$25.46	$38.20	$64.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.73 / $12.31 / $20.69	Professional	26	$7.73	$12.31	$20.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.14 / $25.72 / $43.47	Professional	TC	$17.14	$25.72	$43.47