Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.74 / $349.79 / $786.05	Facility		$63.74	$349.79	$786.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.50 / $12.75 / $60.32	Facility	26	$7.50	$12.75	$60.32
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.08 / $414.78 / $829.56	Facility	TC	$32.08	$414.78	$829.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.56 / $32.77 / $61.53	Professional		$14.56	$32.77	$61.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.30 / $9.27 / $26.32	Professional	26	$7.30	$9.27	$26.32
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.43 / $28.43 / $116.92	Professional	50	$28.43	$28.43	$116.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.64 / $26.59 / $48.12	Professional	TC	$21.64	$26.59	$48.12
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $114.19 / $144.02 / $188.41	Facility		$114.19	$144.02	$188.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.27 / $41.81 / $61.12	Professional		$30.27	$41.81	$61.12
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 $45.20 / $62.85 / $91.68	Professional	50	$45.20	$62.85	$91.68
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.98 / $32.47 / $47.19	Professional	TC	$22.98	$32.47	$47.19
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $35.79 / $41.40 / $89.49	Professional		$35.79	$41.40	$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 $26.48 / $26.96 / $33.70	Professional	TC	$26.48	$26.96	$33.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.64 / $100.43 / $500.00	Facility		$58.64	$100.43	$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 $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.67 / $39.44 / $73.41	Professional		$27.67	$39.44	$73.41
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 $20.97 / $29.26 / $57.66	Professional	TC	$20.97	$29.26	$57.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $36.07 / $43.28 / $53.04	Professional		$36.07	$43.28	$53.04
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 $28.51 / $34.21 / $41.93	Professional	TC	$28.51	$34.21	$41.93
Medcost Facility/Professional Facility Modifier Low / Median / High Price $30.35 / $46.31 / $65.53	Facility		$30.35	$46.31	$65.53
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 $30.24 / $46.95 / $72.09	Facility	TC	$30.24	$46.95	$72.09
Medcost Facility/Professional Professional Modifier Low / Median / High Price $11.09 / $33.00 / $58.00	Professional		$11.09	$33.00	$58.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $9.85 / $32.33 / $65.06	Facility		$9.85	$32.33	$65.06
Sentara Facility/Professional Professional Modifier Low / Median / High Price $12.01 / $38.21 / $79.97	Professional		$12.01	$38.21	$79.97
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 $25.12 / $35.39 / $59.11	Professional	TC	$25.12	$35.39	$59.11
United Facility/Professional Facility Modifier Low / Median / High Price $10.31 / $28.03 / $185.87	Facility		$10.31	$28.03	$185.87
United Facility/Professional Professional Modifier Low / Median / High Price $27.68 / $40.18 / $63.73	Professional		$27.68	$40.18	$63.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $10.75 / $17.80	Professional	26	$6.92	$10.75	$17.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.55 / $30.30 / $47.30	Professional	TC	$19.55	$30.30	$47.30