Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $55.23 / $221.75 / $564.67	Facility		$55.23	$221.75	$564.67
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.22 / $12.27 / $23.05	Facility	26	$7.22	$12.27	$23.05
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.00 / $284.89 / $658.68	Facility	TC	$26.00	$284.89	$658.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.62 / $30.60 / $59.13	Professional		$13.62	$30.60	$59.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.95 / $8.55 / $25.89	Professional	26	$6.95	$8.55	$25.89
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $62.34 / $62.34 / $135.25	Professional	50	$62.34	$62.34	$135.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.06 / $14.89 / $17.28	Professional	52	$12.06	$14.89	$17.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.46 / $24.00 / $44.93	Professional	TC	$19.46	$24.00	$44.93
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $103.94 / $131.08 / $171.49	Facility		$103.94	$131.08	$171.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.14 / $38.53 / $56.21	Professional		$29.14	$38.53	$56.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.21 / $9.30 / $13.84	Professional	26	$7.21	$9.30	$13.84
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $43.39 / $58.90 / $88.80	Professional	50	$43.39	$58.90	$88.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.04 / $29.49 / $43.11	Professional	TC	$21.04	$29.49	$43.11
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $34.61 / $39.71 / $88.31	Professional		$34.61	$39.71	$88.31
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.50 / $10.49 / $13.32	Professional	26	$9.50	$10.49	$13.32
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $24.13 / $26.70 / $33.38	Professional	TC	$24.13	$26.70	$33.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.72 / $96.30 / $500.00	Facility		$53.72	$96.30	$500.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.46 / $29.46 / $29.46	Facility	TC	$29.46	$29.46	$29.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $38.39 / $70.16	Professional		$26.31	$38.39	$70.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.60 / $10.64 / $18.64	Professional	26	$6.60	$10.64	$18.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.35 / $27.29 / $53.65	Professional	TC	$19.35	$27.29	$53.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.82 / $39.38 / $48.26	Professional		$32.82	$39.38	$48.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.27 / $8.98 / $10.82	Professional	26	$7.27	$8.98	$10.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.56 / $30.67 / $37.59	Professional	TC	$25.56	$30.67	$37.59
Medcost Facility/Professional Facility Modifier Low / Median / High Price $28.80 / $44.72 / $61.74	Facility		$28.80	$44.72	$61.74
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $12.39 / $15.00 / $25.33	Facility	26	$12.39	$15.00	$25.33
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $26.39 / $30.45 / $71.81	Facility	TC	$26.39	$30.45	$71.81
Medcost Facility/Professional Professional Modifier Low / Median / High Price $11.00 / $31.00 / $55.00	Professional		$11.00	$31.00	$55.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $10.50 / $30.61 / $61.05	Facility		$10.50	$30.61	$61.05
Sentara Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $36.86 / $75.42	Professional		$11.75	$36.86	$75.42
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.49 / $11.93 / $18.26	Professional	26	$8.49	$11.93	$18.26
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $24.65 / $33.58 / $57.33	Professional	TC	$24.65	$33.58	$57.33
United Facility/Professional Facility Modifier Low / Median / High Price $99.68 / $185.87 / $185.87	Facility		$99.68	$185.87	$185.87
United Facility/Professional Professional Modifier Low / Median / High Price $25.74 / $39.35 / $61.06	Professional		$25.74	$39.35	$61.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.52 / $10.32 / $17.34	Professional	26	$6.52	$10.32	$17.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.89 / $27.08 / $48.07	Professional	TC	$16.89	$27.08	$48.07