Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $82.40 / $208.42 / $532.91	Facility		$82.40	$208.42	$532.91
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.59 / $10.75 / $24.63	Facility	26	$9.59	$10.75	$24.63
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $41.54 / $204.55 / $541.91	Facility	TC	$41.54	$204.55	$541.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.72 / $40.07 / $77.36	Professional		$15.72	$40.07	$77.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.23 / $10.49 / $22.45	Professional	26	$9.23	$10.49	$22.45
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $53.01 / $63.46 / $63.46	Professional	50	$53.01	$63.46	$63.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $33.70 / $61.96	Professional	TC	$27.55	$33.70	$61.96
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $145.93 / $184.04 / $240.77	Facility		$145.93	$184.04	$240.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.15 / $54.71 / $82.19	Professional		$40.15	$54.71	$82.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.61 / $12.36 / $18.84	Professional	26	$9.61	$12.36	$18.84
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $60.04 / $80.26 / $123.75	Professional	50	$60.04	$80.26	$123.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.07 / $42.46 / $60.73	Professional	TC	$31.07	$42.46	$60.73
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $45.50 / $53.59 / $105.29	Professional		$45.50	$53.59	$105.29
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.63 / $12.63 / $16.04	Professional	26	$12.63	$12.63	$16.04
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $32.86 / $34.67 / $43.34	Professional	TC	$32.86	$34.67	$43.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $87.80 / $146.05 / $500.00	Facility		$87.80	$146.05	$500.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $41.38 / $41.38 / $41.38	Facility	TC	$41.38	$41.38	$41.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.13 / $53.88 / $96.35	Professional		$36.13	$53.88	$96.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $14.23 / $23.54	Professional	26	$8.66	$14.23	$23.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.73 / $38.94 / $74.31	Professional	TC	$27.73	$38.94	$74.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.04 / $55.24 / $67.70	Professional		$46.04	$55.24	$67.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.66 / $11.94 / $14.34	Professional	26	$9.66	$11.94	$14.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.36 / $43.65 / $53.49	Professional	TC	$36.36	$43.65	$53.49
Medcost Facility/Professional Facility Modifier Low / Median / High Price $38.36 / $58.42 / $77.36	Facility		$38.36	$58.42	$77.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $16.73 / $16.73 / $33.13	Facility	26	$16.73	$16.73	$33.13
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $40.67 / $41.04 / $97.02	Facility	TC	$40.67	$41.04	$97.02
Medcost Facility/Professional Professional Modifier Low / Median / High Price $14.00 / $42.00 / $82.72	Professional		$14.00	$42.00	$82.72
Sentara Facility/Professional Facility Modifier Low / Median / High Price $13.49 / $40.85 / $80.81	Facility		$13.49	$40.85	$80.81
Sentara Facility/Professional Professional Modifier Low / Median / High Price $14.97 / $49.43 / $99.81	Professional		$14.97	$49.43	$99.81
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $11.34 / $15.27 / $24.18	Professional	26	$11.34	$15.27	$24.18
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $33.04 / $46.42 / $75.76	Professional	TC	$33.04	$46.42	$75.76
United Facility/Professional Professional Modifier Low / Median / High Price $34.65 / $54.52 / $82.49	Professional		$34.65	$54.52	$82.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $13.78 / $21.65	Professional	26	$8.64	$13.78	$21.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.01 / $40.74 / $61.48	Professional	TC	$26.01	$40.74	$61.48