Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $68.88 / $321.06 / $729.48	Facility		$68.88	$321.06	$729.48
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.11 / $13.80 / $47.93	Facility	26	$8.11	$13.80	$47.93
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.23 / $374.86 / $761.76	Facility	TC	$29.23	$374.86	$761.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.38 / $31.07 / $59.57	Professional		$15.38	$31.07	$59.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.81 / $10.11 / $25.94	Professional	26	$7.81	$10.11	$25.94
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $53.34 / $76.08 / $162.00	Professional	50	$53.34	$76.08	$162.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.32 / $25.19 / $44.36	Professional	TC	$18.32	$25.19	$44.36
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $105.94 / $133.60 / $174.78	Facility		$105.94	$133.60	$174.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.39 / $39.28 / $57.30	Professional		$29.39	$39.28	$57.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $10.31 / $15.57	Professional	26	$8.11	$10.31	$15.57
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $44.09 / $60.05 / $89.58	Professional	50	$44.09	$60.05	$89.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.04 / $29.11 / $42.56	Professional	TC	$21.04	$29.11	$42.56
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $33.81 / $39.65 / $97.02	Professional		$33.81	$39.65	$97.02
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.80 / $10.84 / $13.77	Professional	26	$9.80	$10.84	$13.77
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $22.97 / $24.94 / $30.50	Professional	TC	$22.97	$24.94	$30.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.08 / $102.16 / $500.00	Facility		$52.08	$102.16	$500.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.58 / $39.50 / $70.86	Professional		$26.58	$39.50	$70.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.28 / $11.75 / $20.28	Professional	26	$7.28	$11.75	$20.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.13 / $26.93 / $52.12	Professional	TC	$19.13	$26.93	$52.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $33.40 / $40.09 / $49.13	Professional		$33.40	$40.09	$49.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.18 / $10.10 / $12.18	Professional	26	$8.18	$10.10	$12.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.23 / $30.27 / $37.10	Professional	TC	$25.23	$30.27	$37.10
Medcost Facility/Professional Facility Modifier Low / Median / High Price $28.40 / $44.19 / $67.81	Facility		$28.40	$44.19	$67.81
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $13.41 / $16.00 / $29.00	Facility	26	$13.41	$16.00	$29.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $26.55 / $43.28 / $65.17	Facility	TC	$26.55	$43.28	$65.17
Medcost Facility/Professional Professional Modifier Low / Median / High Price $12.34 / $31.00 / $56.00	Professional		$12.34	$31.00	$56.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $11.42 / $30.73 / $61.73	Facility		$11.42	$30.73	$61.73
Sentara Facility/Professional Professional Modifier Low / Median / High Price $12.65 / $37.42 / $75.44	Professional		$12.65	$37.42	$75.44
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $12.90 / $20.39	Professional	26	$9.11	$12.90	$20.39
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $24.14 / $33.03 / $54.77	Professional	TC	$24.14	$33.03	$54.77
United Facility/Professional Professional Modifier Low / Median / High Price $26.28 / $39.90 / $60.35	Professional		$26.28	$39.90	$60.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.42 / $11.24 / $19.07	Professional	26	$7.42	$11.24	$19.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.46 / $28.12 / $42.78	Professional	TC	$18.46	$28.12	$42.78