Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.46 / $248.38 / $521.29	Facility		$44.46	$248.38	$521.29
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.22 / $11.41 / $19.61	Facility	26	$7.22	$11.41	$19.61
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.07 / $370.15 / $792.00	Facility	TC	$21.07	$370.15	$792.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.07 / $28.16 / $49.30	Professional		$21.07	$28.16	$49.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.74 / $7.72 / $17.12	Professional	26	$6.74	$7.72	$17.12
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $103.54 / $117.92 / $117.92	Professional	50	$103.54	$117.92	$117.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.73 / $21.07 / $36.82	Professional	TC	$16.73	$21.07	$36.82
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $89.51 / $112.89 / $147.68	Facility		$89.51	$112.89	$147.68
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.62 / $32.86 / $48.92	Professional		$25.62	$32.86	$48.92
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.21 / $8.99 / $13.79	Professional	26	$7.21	$8.99	$13.79
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $38.43 / $49.39 / $76.14	Professional	50	$38.43	$49.39	$76.14
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.87 / $23.89 / $34.97	Professional	TC	$17.87	$23.89	$34.97
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $31.73 / $31.73 / $85.09	Professional		$31.73	$31.73	$85.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $8.59 / $10.91	Professional	26	$8.11	$8.59	$10.91
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $23.14 / $29.39	Professional	TC	$22.51	$23.14	$29.39
Cigna Facility/Professional Facility Modifier Low / Median / High Price $51.27 / $84.14 / $500.00	Facility		$51.27	$84.14	$500.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $23.86 / $23.86 / $23.86	Facility	TC	$23.86	$23.86	$23.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.34 / $35.50 / $60.93	Professional		$23.34	$35.50	$60.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.44 / $10.00 / $17.52	Professional	26	$6.44	$10.00	$17.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.79 / $25.32 / $43.75	Professional	TC	$16.79	$25.32	$43.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.24 / $33.88 / $41.53	Professional		$28.24	$33.88	$41.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.27 / $8.98 / $10.82	Professional	26	$7.27	$8.98	$10.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.97 / $25.16 / $30.84	Professional	TC	$20.97	$25.16	$30.84
Medcost Facility/Professional Facility Modifier Low / Median / High Price $24.77 / $38.29 / $57.92	Facility		$24.77	$38.29	$57.92
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $10.74 / $13.70 / $24.78	Facility	26	$10.74	$13.70	$24.78
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $23.85 / $29.87 / $61.50	Facility	TC	$23.85	$29.87	$61.50
Medcost Facility/Professional Professional Modifier Low / Median / High Price $10.19 / $29.00 / $49.00	Professional		$10.19	$29.00	$49.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $9.06 / $27.36 / $53.17	Facility		$9.06	$27.36	$53.17
Sentara Facility/Professional Professional Modifier Low / Median / High Price $10.48 / $33.61 / $64.11	Professional		$10.48	$33.61	$64.11
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.06 / $10.95 / $18.12	Professional	26	$8.06	$10.95	$18.12
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $21.15 / $29.03 / $46.00	Professional	TC	$21.15	$29.03	$46.00
United Facility/Professional Facility Modifier Low / Median / High Price $9.02 / $26.60 / $185.87	Facility		$9.02	$26.60	$185.87
United Facility/Professional Professional Modifier Low / Median / High Price $22.19 / $34.29 / $54.51	Professional		$22.19	$34.29	$54.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.25 / $9.52 / $15.61	Professional	26	$6.25	$9.52	$15.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.20 / $24.00 / $38.03	Professional	TC	$15.20	$24.00	$38.03