Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $68.08 / $304.47 / $804.50	Facility		$68.08	$304.47	$804.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.18 / $16.30 / $29.68	Facility	26	$10.18	$16.30	$29.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.46 / $381.45 / $741.36	Facility	TC	$33.46	$381.45	$741.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.61 / $38.56 / $67.04	Professional		$32.61	$38.56	$67.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.23 / $11.11 / $23.04	Professional	26	$9.23	$11.11	$23.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.42 / $28.97 / $50.15	Professional	TC	$22.42	$28.97	$50.15
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 $34.85 / $44.80 / $65.48	Professional		$34.85	$44.80	$65.48
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 $24.39 / $32.85 / $48.01	Professional	TC	$24.39	$32.85	$48.01
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $39.29 / $45.15 / $114.06	Professional		$39.29	$45.15	$114.06
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 $26.61 / $27.92 / $34.90	Professional	TC	$26.61	$27.92	$34.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $62.73 / $117.87 / $500.00	Facility		$62.73	$117.87	$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 $32.79 / $32.79 / $32.79	Facility	TC	$32.79	$32.79	$32.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.77 / $47.65 / $81.89	Professional		$30.77	$47.65	$81.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $13.97 / $23.97	Professional	26	$8.66	$13.97	$23.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.44 / $32.90 / $59.24	Professional	TC	$22.44	$32.90	$59.24
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 $33.92 / $52.83 / $79.59	Facility		$33.92	$52.83	$79.59
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $16.02 / $23.00 / $36.00	Facility	26	$16.02	$23.00	$36.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $30.65 / $54.23 / $78.79	Facility	TC	$30.65	$54.23	$78.79
Medcost Facility/Professional Professional Modifier Low / Median / High Price $14.70 / $37.00 / $67.00	Professional		$14.70	$37.00	$67.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $13.39 / $36.50 / $71.14	Facility		$13.39	$36.50	$71.14
Sentara Facility/Professional Professional Modifier Low / Median / High Price $15.08 / $44.78 / $88.94	Professional		$15.08	$44.78	$88.94
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 $28.29 / $38.27 / $62.26	Professional	TC	$28.29	$38.27	$62.26
United Facility/Professional Professional Modifier Low / Median / High Price $30.62 / $45.94 / $70.26	Professional		$30.62	$45.94	$70.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.53 / $13.78 / $22.81	Professional	26	$8.53	$13.78	$22.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.17 / $32.15 / $50.45	Professional	TC	$21.17	$32.15	$50.45