Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.79 / $253.47 / $673.35	Facility		$67.79	$253.47	$673.35
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.59 / $13.66 / $30.32	Facility	26	$9.59	$13.66	$30.32
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.28 / $253.85 / $680.98	Facility	TC	$30.28	$253.85	$680.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.70 / $38.29 / $70.55	Professional		$33.70	$38.29	$70.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.98 / $10.35 / $20.94	Professional	26	$8.98	$10.35	$20.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.01 / $27.51 / $51.47	Professional	TC	$24.01	$27.51	$51.47
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $126.35 / $159.35 / $208.47	Facility		$126.35	$159.35	$208.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.02 / $47.65 / $72.38	Professional		$37.02	$47.65	$72.38
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.61 / $12.36 / $18.87	Professional	26	$9.61	$12.36	$18.87
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $55.53 / $70.90 / $107.30	Professional	50	$55.53	$70.90	$107.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.13 / $35.20 / $52.85	Professional	TC	$26.13	$35.20	$52.85
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $43.89 / $46.82 / $120.48	Professional		$43.89	$46.82	$120.48
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $12.87 / $13.06 / $16.59	Professional	26	$12.87	$13.06	$16.59
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $30.83 / $31.15 / $39.15	Professional	TC	$30.83	$31.15	$39.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $72.73 / $123.24 / $500.00	Facility		$72.73	$123.24	$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 $34.29 / $34.29 / $34.29	Facility	TC	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.74 / $49.96 / $88.59	Professional		$32.74	$49.96	$88.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $14.38 / $23.97	Professional	26	$8.66	$14.38	$23.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.48 / $34.96 / $62.69	Professional	TC	$23.48	$34.96	$62.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $47.77 / $58.54	Professional		$39.81	$47.77	$58.54
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 $30.14 / $36.17 / $44.33	Professional	TC	$30.14	$36.17	$44.33
Medcost Facility/Professional Facility Modifier Low / Median / High Price $34.20 / $53.93 / $69.19	Facility		$34.20	$53.93	$69.19
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $19.48 / $30.08 / $39.90	Facility	26	$19.48	$30.08	$39.90
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $34.32 / $38.86 / $79.03	Facility	TC	$34.32	$38.86	$79.03
Medcost Facility/Professional Professional Modifier Low / Median / High Price $15.00 / $38.00 / $72.14	Professional		$15.00	$38.00	$72.14
Sentara Facility/Professional Facility Modifier Low / Median / High Price $13.81 / $37.90 / $71.14	Facility		$13.81	$37.90	$71.14
Sentara Facility/Professional Professional Modifier Low / Median / High Price $15.33 / $47.30 / $88.01	Professional		$15.33	$47.30	$88.01
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $11.70 / $15.33 / $24.18	Professional	26	$11.70	$15.33	$24.18
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $28.58 / $39.76 / $63.84	Professional	TC	$28.58	$39.76	$63.84
United Facility/Professional Professional Modifier Low / Median / High Price $31.55 / $48.07 / $75.11	Professional		$31.55	$48.07	$75.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.07 / $13.78 / $21.81	Professional	26	$9.07	$13.78	$21.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.40 / $34.29 / $53.77	Professional	TC	$22.40	$34.29	$53.77