Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.36 / $337.40 / $756.92	Facility		$77.36	$337.40	$756.92
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.50 / $12.75 / $24.68	Facility	26	$7.50	$12.75	$24.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.26 / $418.47 / $811.64	Facility	TC	$32.26	$418.47	$811.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.71 / $36.54 / $70.09	Professional		$14.71	$36.54	$70.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.23 / $8.43 / $25.49	Professional	26	$7.23	$8.43	$25.49
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.43 / $28.48 / $127.64	Professional	50	$28.43	$28.48	$127.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.64 / $31.15 / $57.10	Professional	TC	$24.64	$31.15	$57.10
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $126.57 / $159.62 / $208.82	Facility		$126.57	$159.62	$208.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.88 / $46.29 / $67.66	Professional		$32.88	$46.29	$67.66
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 $49.32 / $69.58 / $101.49	Professional	50	$49.32	$69.58	$101.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.14 / $36.96 / $53.69	Professional	TC	$26.14	$36.96	$53.69
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $41.83 / $45.83 / $89.49	Professional		$41.83	$45.83	$89.49
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 $32.52 / $33.21 / $41.51	Professional	TC	$32.52	$33.21	$41.51
Cigna Facility/Professional Facility Modifier Low / Median / High Price $70.93 / $115.55 / $500.00	Facility		$70.93	$115.55	$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 $36.90 / $36.90 / $36.90	Facility	TC	$36.90	$36.90	$36.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.70 / $43.67 / $82.38	Professional		$29.70	$43.67	$82.38
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 $22.76 / $32.90 / $66.36	Professional	TC	$22.76	$32.90	$66.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.99 / $47.99 / $58.81	Professional		$39.99	$47.99	$58.81
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 $32.44 / $38.92 / $47.70	Professional	TC	$32.44	$38.92	$47.70
Medcost Facility/Professional Facility Modifier Low / Median / High Price $33.20 / $49.74 / $71.18	Facility		$33.20	$49.74	$71.18
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $12.15 / $15.00 / $25.84	Facility	26	$12.15	$15.00	$25.84
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $33.33 / $53.28 / $85.58	Facility	TC	$33.33	$53.28	$85.58
Medcost Facility/Professional Professional Modifier Low / Median / High Price $11.09 / $38.00 / $65.00	Professional		$11.09	$38.00	$65.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $9.85 / $36.10 / $72.45	Facility		$9.85	$36.10	$72.45
Sentara Facility/Professional Professional Modifier Low / Median / High Price $12.01 / $42.71 / $89.01	Professional		$12.01	$42.71	$89.01
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $11.92 / $18.88	Professional	26	$8.66	$11.92	$18.88
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $30.01 / $42.02 / $69.73	Professional	TC	$30.01	$42.02	$69.73
United Facility/Professional Professional Modifier Low / Median / High Price $28.24 / $42.90 / $70.73	Professional		$28.24	$42.90	$70.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.67 / $10.68 / $17.80	Professional	26	$6.67	$10.68	$17.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.38 / $33.54 / $55.98	Professional	TC	$20.38	$33.54	$55.98