Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $194.98 / $537.03	Facility		$57.54	$194.98	$537.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.76 / $12.88 / $34.67	Facility	26	$7.76	$12.88	$34.67
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $134.90 / $501.19	Facility	TC	$25.70	$134.90	$501.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $30.90 / $95.50	Professional		$8.51	$30.90	$95.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $12.02 / $38.90	Professional	26	$7.41	$12.02	$38.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.18 / $125.89 / $177.83	Professional	50	$28.18	$125.89	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $28.84 / $60.26	Professional	TC	$19.95	$28.84	$60.26
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $147.91 / $186.21	Facility		$125.89	$147.91	$186.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $46.77 / $70.79	Professional		$33.11	$46.77	$70.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $11.48 / $17.38	Professional	26	$8.13	$11.48	$17.38
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $48.98 / $69.18 / $104.71	Professional	50	$48.98	$69.18	$104.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $35.48 / $53.70	Professional	TC	$25.12	$35.48	$53.70
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $8.32 / $36.31 / $89.13	Professional		$8.32	$36.31	$89.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $11.48 / $14.13	Professional	26	$9.55	$11.48	$14.13
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $38.90 / $47.86	Professional	TC	$33.88	$38.90	$47.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $109.65 / $524.81	Facility		$54.95	$109.65	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.31 / $29.51 / $41.69	Facility	TC	$6.31	$29.51	$41.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $41.69 / $72.44	Professional		$26.92	$41.69	$72.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $11.22 / $19.50	Professional	26	$6.76	$11.22	$19.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $28.84 / $54.95	Professional	TC	$19.95	$28.84	$54.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $41.69 / $51.29	Professional		$34.67	$41.69	$51.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.00 / $12.02	Professional	26	$7.94	$10.00	$12.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $32.36 / $39.81	Professional	TC	$26.30	$32.36	$39.81
Medcost Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Professional		$75.86	$75.86	$75.86
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $19.05 / $19.05	Professional	26	$19.05	$19.05	$19.05
Medcost Facility/Professional Facility Modifier Low / Median / High Price $28.84 / $41.69 / $66.07	Facility		$28.84	$41.69	$66.07
Medcost Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $28.18 / $57.54	Professional		$28.18	$28.18	$57.54
Sentara Facility/Professional Facility Modifier Low / Median / High Price $10.72 / $30.90 / $70.79	Facility		$10.72	$30.90	$70.79
Sentara Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $37.15 / $114.82	Professional		$11.48	$37.15	$114.82
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $11.48 / $19.95	Professional	26	$9.12	$11.48	$19.95
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $30.90 / $57.54	Professional	TC	$22.39	$30.90	$57.54
United Facility/Professional Facility Modifier Low / Median / High Price $9.55 / $30.90 / $186.21	Facility		$9.55	$30.90	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $38.90 / $66.07	Professional		$25.70	$38.90	$66.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $10.23 / $18.62	Professional	26	$6.92	$10.23	$18.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $27.54 / $47.86	Professional	TC	$18.20	$27.54	$47.86