Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.47 / $172.90 / $540.20	Facility		$39.47	$172.90	$540.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.22 / $12.27 / $22.60	Facility	26	$7.22	$12.27	$22.60
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.03 / $353.71 / $823.90	Facility	TC	$23.03	$353.71	$823.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.26 / $28.05 / $52.78	Professional		$20.26	$28.05	$52.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.95 / $7.87 / $21.33	Professional	26	$6.95	$7.87	$21.33
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.00 / $56.12 / $150.21	Professional	50	$33.00	$56.12	$150.21
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.53 / $13.59 / $15.74	Professional	52	$10.53	$13.59	$15.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $21.57 / $40.29	Professional	TC	$17.89	$21.57	$40.29
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $95.71 / $120.71 / $157.91	Facility		$95.71	$120.71	$157.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.59 / $35.47 / $51.85	Professional		$26.59	$35.47	$51.85
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.21 / $9.08 / $13.84	Professional	26	$7.21	$9.08	$13.84
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $39.89 / $53.32 / $81.92	Professional	50	$39.89	$53.32	$81.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.29 / $26.50 / $38.74	Professional	TC	$19.29	$26.50	$38.74
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.55 / $35.14 / $82.57	Professional		$30.55	$35.14	$82.57
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $8.94 / $11.37	Professional	26	$8.91	$8.94	$11.37
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $21.60 / $23.62 / $29.53	Professional	TC	$21.60	$23.62	$29.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $48.81 / $84.14 / $500.00	Facility		$48.81	$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 $26.47 / $26.47 / $26.47	Facility	TC	$26.47	$26.47	$26.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.16 / $35.83 / $63.74	Professional		$24.16	$35.83	$63.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.44 / $18.03	Professional	26	$6.46	$10.44	$18.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.61 / $24.83 / $47.45	Professional	TC	$17.61	$24.83	$47.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $36.24 / $44.41	Professional		$30.20	$36.24	$44.41
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 $22.93 / $27.52 / $33.72	Professional	TC	$22.93	$27.52	$33.72
Medcost Facility/Professional Facility Modifier Low / Median / High Price $25.95 / $39.94 / $57.73	Facility		$25.95	$39.94	$57.73
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $11.13 / $14.00 / $23.35	Facility	26	$11.13	$14.00	$23.35
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $39.82 / $62.65	Facility	TC	$26.10	$39.82	$62.65
Medcost Facility/Professional Professional Modifier Low / Median / High Price $11.00 / $28.00 / $48.00	Professional		$11.00	$28.00	$48.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $9.44 / $27.71 / $56.42	Facility		$9.44	$27.71	$56.42
Sentara Facility/Professional Professional Modifier Low / Median / High Price $11.00 / $33.36 / $68.64	Professional		$11.00	$33.36	$68.64
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.33 / $11.34 / $18.12	Professional	26	$8.33	$11.34	$18.12
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $22.12 / $30.14 / $50.52	Professional	TC	$22.12	$30.14	$50.52
United Facility/Professional Facility Modifier Low / Median / High Price $35.76 / $250.18 / $250.18	Facility		$35.76	$250.18	$250.18
United Facility/Professional Professional Modifier Low / Median / High Price $23.09 / $36.29 / $55.66	Professional		$23.09	$36.29	$55.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.41 / $9.99 / $15.61	Professional	26	$6.41	$9.99	$15.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.21 / $25.97 / $39.54	Professional	TC	$17.21	$25.97	$39.54