Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.64 / $254.48 / $532.91	Facility		$53.64	$254.48	$532.91
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.22 / $12.27 / $22.70	Facility	26	$7.22	$12.27	$22.70
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.03 / $340.54 / $541.91	Facility	TC	$24.03	$340.54	$541.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.70 / $28.79 / $53.93	Professional		$20.70	$28.79	$53.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.95 / $7.95 / $21.04	Professional	26	$6.95	$7.95	$21.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $22.91 / $42.04	Professional	TC	$18.82	$22.91	$42.04
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $97.77 / $123.30 / $161.31	Facility		$97.77	$123.30	$161.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.15 / $35.84 / $54.08	Professional		$28.15	$35.84	$54.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.91 / $9.03 / $13.32	Professional	26	$6.91	$9.03	$13.32
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.23 / $27.25 / $39.83	Professional	TC	$20.23	$27.25	$39.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $32.01 / $36.17 / $95.99	Professional		$32.01	$36.17	$95.99
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.24 / $9.31 / $11.82	Professional	26	$9.24	$9.31	$11.82
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $22.70 / $24.94 / $30.82	Professional	TC	$22.70	$24.94	$30.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $51.27 / $97.22 / $500.00	Facility		$51.27	$97.22	$500.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
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 $25.07 / $37.83 / $67.06	Professional		$25.07	$37.83	$67.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.27 / $10.45 / $18.25	Professional	26	$6.27	$10.45	$18.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.57 / $27.01 / $49.52	Professional	TC	$18.57	$27.01	$49.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.86 / $37.03 / $45.38	Professional		$30.86	$37.03	$45.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $6.94 / $8.57 / $10.61	Professional	26	$6.94	$8.57	$10.61
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 $26.96 / $42.33 / $63.09	Facility		$26.96	$42.33	$63.09
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $12.39 / $15.00 / $25.08	Facility	26	$12.39	$15.00	$25.08
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $26.39 / $39.22 / $66.08	Facility	TC	$26.39	$39.22	$66.08
Medcost Facility/Professional Professional Modifier Low / Median / High Price $11.00 / $30.25 / $52.00	Professional		$11.00	$30.25	$52.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $10.37 / $29.98 / $58.41	Facility		$10.37	$29.98	$58.41
Sentara Facility/Professional Professional Modifier Low / Median / High Price $11.57 / $36.10 / $70.90	Professional		$11.57	$36.10	$70.90
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.49 / $11.44 / $18.12	Professional	26	$8.49	$11.44	$18.12
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $23.33 / $31.46 / $52.80	Professional	TC	$23.33	$31.46	$52.80
United Facility/Professional Professional Modifier Low / Median / High Price $24.85 / $37.75 / $63.52	Professional		$24.85	$37.75	$63.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.43 / $10.01 / $17.30	Professional	26	$6.43	$10.01	$17.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.05 / $26.37 / $41.66	Professional	TC	$18.05	$26.37	$41.66