Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $323.59 / $776.25	Facility		$58.88	$323.59	$776.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $12.88 / $41.69	Facility	26	$7.08	$12.88	$41.69
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.92 / $128.82 / $794.33	Facility	TC	$26.92	$128.82	$794.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $34.67 / $104.71	Professional		$8.71	$34.67	$104.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $16.22 / $46.77	Professional	26	$7.76	$16.22	$46.77
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.20 / $69.18 / $190.55	Professional	50	$18.20	$69.18	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $34.67 / $81.28	Professional	TC	$21.88	$34.67	$81.28
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $158.49 / $199.53	Facility		$134.90	$158.49	$199.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $47.86 / $74.13	Professional		$33.11	$47.86	$74.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $10.72 / $16.60	Professional	26	$7.76	$10.72	$16.60
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $50.12 / $72.44 / $114.82	Professional	50	$50.12	$72.44	$114.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $36.31 / $57.54	Professional	TC	$23.99	$36.31	$57.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $7.94 / $42.66 / $91.20	Professional		$7.94	$42.66	$91.20
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $8.91 / $12.59	Professional	26	$8.32	$8.91	$12.59
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.88 / $47.86	Professional	TC	$22.91	$33.88	$47.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $114.82 / $524.81	Facility		$58.88	$114.82	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	TC	$6.76	$31.62	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $39.81 / $74.13	Professional		$27.54	$39.81	$74.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $10.47 / $18.20	Professional	26	$6.61	$10.47	$18.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.84 / $58.88	Professional	TC	$20.42	$28.84	$58.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $45.71 / $56.23	Professional		$38.02	$45.71	$56.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $10.00 / $12.59	Professional	26	$8.13	$10.00	$12.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $35.48 / $43.65	Professional	TC	$28.84	$35.48	$43.65
Medcost Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $45.71 / $79.43	Professional		$37.15	$45.71	$79.43
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $15.49 / $18.20	Professional	26	$12.30	$15.49	$18.20
Medcost Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $44.67 / $69.18	Facility		$30.20	$44.67	$69.18
Medcost Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $30.20 / $58.88	Professional		$30.20	$30.20	$58.88
Sentara Facility/Professional Facility Modifier Low / Median / High Price $9.77 / $31.62 / $85.11	Facility		$9.77	$31.62	$85.11
Sentara Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $37.15 / $144.54	Professional		$10.72	$37.15	$144.54
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $11.22 / $19.05	Professional	26	$8.51	$11.22	$19.05
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $32.36 / $60.26	Professional	TC	$21.38	$32.36	$60.26
United Facility/Professional Facility Modifier Low / Median / High Price $8.51 / $28.18 / $186.21	Facility		$8.51	$28.18	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $37.15 / $64.57	Professional		$23.44	$37.15	$64.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $9.77 / $16.98	Professional	26	$6.46	$9.77	$16.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $27.54 / $48.98	Professional	TC	$17.78	$27.54	$48.98