Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $245.47 / $660.69	Facility		$66.07	$245.47	$660.69
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $16.22 / $42.66	Facility	26	$8.91	$16.22	$42.66
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $120.23 / $660.69	Facility	TC	$30.20	$120.23	$660.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $46.77 / $114.82	Professional		$31.62	$46.77	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.13 / $35.48	Professional	26	$8.91	$14.13	$35.48
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $26.92 / $147.91 / $177.83	Professional	50	$26.92	$147.91	$177.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.78 / $17.78 / $17.78	Professional	52	$17.78	$17.78	$17.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.90 / $66.07	Professional	TC	$22.91	$30.90	$66.07
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $173.78 / $218.78	Facility		$147.91	$173.78	$218.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $54.95 / $81.28	Professional		$38.02	$54.95	$81.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.13 / $21.38	Professional	26	$10.00	$14.13	$21.38
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $57.54 / $79.43 / $123.03	Professional	50	$57.54	$79.43	$123.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $40.74 / $60.26	Professional	TC	$28.18	$40.74	$60.26
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $46.77 / $123.03	Professional		$35.48	$46.77	$123.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $11.48 / $14.45	Professional	26	$10.23	$11.48	$14.45
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $31.62 / $53.70	Professional	TC	$31.62	$31.62	$53.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $123.03 / $524.81	Facility		$64.57	$123.03	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $7.08 / $33.11 / $47.86	Facility	TC	$7.08	$33.11	$47.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $50.12 / $85.11	Professional		$31.62	$50.12	$85.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $13.80 / $23.99	Professional	26	$8.32	$13.80	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $34.67 / $63.10	Professional	TC	$23.44	$34.67	$63.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $50.12 / $60.26	Professional		$41.69	$50.12	$60.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $12.30 / $14.79	Professional	26	$10.00	$12.30	$14.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $38.02 / $45.71	Professional	TC	$30.90	$38.02	$45.71
Medcost Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $89.13	Professional		$89.13	$89.13	$89.13
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $23.44 / $23.44	Professional	26	$23.44	$23.44	$23.44
Medcost Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $50.12 / $77.62	Facility		$33.88	$50.12	$77.62
Medcost Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $34.67 / $67.61	Professional		$34.67	$34.67	$67.61
Sentara Facility/Professional Facility Modifier Low / Median / High Price $13.18 / $36.31 / $81.28	Facility		$13.18	$36.31	$81.28
Sentara Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $43.65 / $134.90	Professional		$14.13	$43.65	$134.90
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $14.45 / $23.99	Professional	26	$11.22	$14.45	$23.99
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $37.15 / $64.57	Professional	TC	$27.54	$37.15	$64.57
United Facility/Professional Facility Modifier Low / Median / High Price $11.75 / $38.02 / $251.19	Facility		$11.75	$38.02	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $46.77 / $79.43	Professional		$30.90	$46.77	$79.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $12.59 / $22.91	Professional	26	$8.51	$12.59	$22.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $32.36 / $56.23	Professional	TC	$22.39	$32.36	$56.23