Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.31 / $208.06 / $509.17	Facility		$37.31	$208.06	$509.17
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.50 / $12.41 / $22.43	Facility	26	$7.50	$12.41	$22.43
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.03 / $237.08 / $401.69	Facility	TC	$24.03	$237.08	$401.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.46 / $30.30 / $56.12	Professional		$26.46	$30.30	$56.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.11 / $8.02 / $17.57	Professional	26	$7.11	$8.02	$17.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $22.18 / $42.04	Professional	TC	$19.14	$22.18	$42.04
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $99.79 / $125.86 / $164.65	Facility		$99.79	$125.86	$164.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.53 / $36.59 / $54.08	Professional		$28.53	$36.59	$54.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.51 / $9.56 / $14.43	Professional	26	$7.51	$9.56	$14.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.25 / $27.25 / $39.83	Professional	TC	$20.25	$27.25	$39.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $31.64 / $36.24 / $95.99	Professional		$31.64	$36.24	$95.99
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.27 / $9.31 / $11.82	Professional	26	$9.27	$9.31	$11.82
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $22.33 / $24.94 / $30.82	Professional	TC	$22.33	$24.94	$30.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $50.45 / $97.74 / $500.00	Facility		$50.45	$97.74	$500.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $27.22 / $27.22 / $27.22	Facility	TC	$27.22	$27.22	$27.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.15 / $38.53 / $67.68	Professional		$25.15	$38.53	$67.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.74 / $10.91 / $18.75	Professional	26	$6.74	$10.91	$18.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.57 / $27.41 / $49.52	Professional	TC	$18.57	$27.41	$49.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $31.48 / $37.77 / $46.29	Professional		$31.48	$37.77	$46.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.56 / $9.33 / $11.26	Professional	26	$7.56	$9.33	$11.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.92 / $28.70 / $35.18	Professional	TC	$23.92	$28.70	$35.18
Medcost Facility/Professional Facility Modifier Low / Median / High Price $27.76 / $42.60 / $63.90	Facility		$27.76	$42.60	$63.90
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $12.29 / $15.00 / $25.84	Facility	26	$12.29	$15.00	$25.84
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $27.22 / $44.08 / $65.34	Facility	TC	$27.22	$44.08	$65.34
Medcost Facility/Professional Professional Modifier Low / Median / High Price $11.09 / $30.25 / $52.00	Professional		$11.09	$30.25	$52.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $10.68 / $29.98 / $58.41	Facility		$10.68	$29.98	$58.41
Sentara Facility/Professional Professional Modifier Low / Median / High Price $12.01 / $35.65 / $70.90	Professional		$12.01	$35.65	$70.90
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.59 / $11.92 / $18.88	Professional	26	$8.59	$11.92	$18.88
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $23.33 / $31.46 / $52.04	Professional	TC	$23.33	$31.46	$52.04
United Facility/Professional Professional Modifier Low / Median / High Price $25.17 / $37.75 / $57.64	Professional		$25.17	$37.75	$57.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.77 / $10.55 / $16.37	Professional	26	$6.77	$10.55	$16.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.77 / $27.00 / $42.59	Professional	TC	$17.77	$27.00	$42.59