Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.53 / $290.32 / $685.52	Facility		$63.53	$290.32	$685.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.50 / $12.41 / $23.67	Facility	26	$7.50	$12.41	$23.67
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.03 / $399.95 / $796.08	Facility	TC	$24.03	$399.95	$796.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.27 / $30.61 / $55.25	Professional		$13.27	$30.61	$55.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.23 / $8.21 / $22.86	Professional	26	$7.23	$8.21	$22.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $100.30 / $100.30 / $100.30	Professional	50	$100.30	$100.30	$100.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $24.03 / $45.59	Professional	TC	$18.62	$24.03	$45.59
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 $29.74 / $37.04 / $56.90	Professional		$29.74	$37.04	$56.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.51 / $9.55 / $14.43	Professional	26	$7.51	$9.55	$14.43
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $44.61 / $55.56 / $86.05	Professional	50	$44.61	$55.56	$86.05
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.30 / $27.68 / $40.38	Professional	TC	$21.30	$27.68	$40.38
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $37.29 / $37.29 / $95.99	Professional		$37.29	$37.29	$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 $25.19 / $27.99 / $35.54	Professional	TC	$25.19	$27.99	$35.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $59.07 / $88.99 / $500.00	Facility		$59.07	$88.99	$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 $27.59 / $27.59 / $27.59	Facility	TC	$27.59	$27.59	$27.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.40 / $40.47 / $67.68	Professional		$25.40	$40.47	$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 $19.25 / $29.79 / $49.52	Professional	TC	$19.25	$29.79	$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 $27.65 / $44.77 / $67.11	Facility		$27.65	$44.77	$67.11
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 / $54.34 / $71.81	Facility	TC	$27.22	$54.34	$71.81
Medcost Facility/Professional Professional Modifier Low / Median / High Price $11.09 / $36.29 / $56.00	Professional		$11.09	$36.29	$56.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $9.85 / $31.46 / $57.83	Facility		$9.85	$31.46	$57.83
Sentara Facility/Professional Professional Modifier Low / Median / High Price $12.01 / $39.10 / $72.30	Professional		$12.01	$39.10	$72.30
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 $23.93 / $32.96 / $51.45	Professional	TC	$23.93	$32.96	$51.45
United Facility/Professional Professional Modifier Low / Median / High Price $24.89 / $37.33 / $60.41	Professional		$24.89	$37.33	$60.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.77 / $10.75 / $17.30	Professional	26	$6.77	$10.75	$17.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.72 / $26.58 / $44.66	Professional	TC	$17.72	$26.58	$44.66