Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.30 / $198.42 / $658.75	Facility		$44.30	$198.42	$658.75
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 $23.07 / $204.55 / $862.62	Facility	TC	$23.07	$204.55	$862.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.44 / $31.00 / $57.52	Professional		$22.44	$31.00	$57.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.95 / $7.87 / $17.62	Professional	26	$6.95	$7.87	$17.62
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $98.00 / $98.00 / $175.68	Professional	50	$98.00	$98.00	$175.68
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.43 / $14.74 / $17.11	Professional	52	$11.43	$14.74	$17.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $23.69 / $43.65	Professional	TC	$20.07	$23.69	$43.65
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $102.91 / $129.79 / $169.79	Facility		$102.91	$129.79	$169.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.66 / $38.08 / $55.66	Professional		$27.66	$38.08	$55.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.21 / $9.18 / $13.84	Professional	26	$7.21	$9.18	$13.84
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $41.45 / $57.24 / $83.64	Professional	50	$41.45	$57.24	$83.64
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.68 / $29.08 / $42.56	Professional	TC	$20.68	$29.08	$42.56
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $36.17 / $38.45 / $82.57	Professional		$36.17	$38.45	$82.57
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.23 / $10.13 / $12.87	Professional	26	$9.23	$10.13	$12.87
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $25.89 / $26.37 / $33.07	Professional	TC	$25.89	$26.37	$33.07
Cigna Facility/Professional Facility Modifier Low / Median / High Price $56.18 / $93.55 / $500.00	Facility		$56.18	$93.55	$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 $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.33 / $37.09 / $69.81	Professional		$25.33	$37.09	$69.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.60 / $10.44 / $18.03	Professional	26	$6.60	$10.44	$18.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.19 / $27.41 / $52.96	Professional	TC	$19.19	$27.41	$52.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.50 / $38.99 / $47.79	Professional		$32.50	$38.99	$47.79
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 $25.23 / $30.27 / $37.10	Professional	TC	$25.23	$30.27	$37.10
Medcost Facility/Professional Facility Modifier Low / Median / High Price $28.48 / $40.78 / $60.19	Facility		$28.48	$40.78	$60.19
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $11.87 / $14.00 / $24.00	Facility	26	$11.87	$14.00	$24.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $29.00 / $42.21 / $67.14	Facility	TC	$29.00	$42.21	$67.14
Medcost Facility/Professional Professional Modifier Low / Median / High Price $11.00 / $31.00 / $56.00	Professional		$11.00	$31.00	$56.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $10.42 / $30.55 / $61.06	Facility		$10.42	$30.55	$61.06
Sentara Facility/Professional Professional Modifier Low / Median / High Price $11.24 / $37.40 / $74.68	Professional		$11.24	$37.40	$74.68
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.33 / $11.53 / $18.12	Professional	26	$8.33	$11.53	$18.12
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $24.08 / $33.64 / $56.45	Professional	TC	$24.08	$33.64	$56.45
United Facility/Professional Professional Modifier Low / Median / High Price $24.67 / $36.40 / $60.41	Professional		$24.67	$36.40	$60.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.45 / $9.99 / $16.96	Professional	26	$6.45	$9.99	$16.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.64 / $26.30 / $45.23	Professional	TC	$18.64	$26.30	$45.23