Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $71.06 / $266.24 / $759.67	Facility		$71.06	$266.24	$759.67
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.11 / $13.80 / $49.44	Facility	26	$8.11	$13.80	$49.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $35.53 / $359.38 / $768.96	Facility	TC	$35.53	$359.38	$768.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.73 / $36.89 / $68.86	Professional		$15.73	$36.89	$68.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.81 / $9.61 / $26.96	Professional	26	$7.81	$9.61	$26.96
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $3.40 / $38.15 / $162.12	Professional	50	$3.40	$38.15	$162.12
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.84 / $17.80 / $20.67	Professional	52	$13.84	$17.80	$20.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $29.94 / $54.79	Professional	TC	$24.44	$29.94	$54.79
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $124.48 / $156.99 / $205.38	Facility		$124.48	$156.99	$205.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.25 / $45.92 / $72.30	Professional		$33.25	$45.92	$72.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $10.31 / $15.57	Professional	26	$8.11	$10.31	$15.57
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $49.87 / $69.02 / $108.45	Professional	50	$49.87	$69.02	$108.45
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.46 / $35.84 / $56.51	Professional	TC	$25.46	$35.84	$56.51
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $42.12 / $46.30 / $97.02	Professional		$42.12	$46.30	$97.02
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $9.80 / $10.84 / $13.77	Professional	26	$9.80	$10.84	$13.77
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $31.28 / $32.52 / $40.65	Professional	TC	$31.28	$32.52	$40.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $67.65 / $114.17 / $500.00	Facility		$67.65	$114.17	$500.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.79 / $35.79 / $35.79	Facility	TC	$35.79	$35.79	$35.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.18 / $44.11 / $83.64	Professional		$30.18	$44.11	$83.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.28 / $11.75 / $20.28	Professional	26	$7.28	$11.75	$20.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.05 / $32.40 / $65.36	Professional	TC	$23.05	$32.40	$65.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.29 / $47.16 / $57.80	Professional		$39.29	$47.16	$57.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.18 / $10.10 / $12.18	Professional	26	$8.18	$10.10	$12.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.13 / $37.35 / $45.78	Professional	TC	$31.13	$37.35	$45.78
Medcost Facility/Professional Facility Modifier Low / Median / High Price $33.36 / $52.24 / $72.08	Facility		$33.36	$52.24	$72.08
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $13.41 / $16.00 / $32.04	Facility	26	$13.41	$16.00	$32.04
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $34.65 / $51.97 / $84.42	Facility	TC	$34.65	$51.97	$84.42
Medcost Facility/Professional Professional Modifier Low / Median / High Price $12.34 / $37.00 / $65.00	Professional		$12.34	$37.00	$65.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $11.42 / $35.76 / $73.02	Facility		$11.42	$35.76	$73.02
Sentara Facility/Professional Professional Modifier Low / Median / High Price $12.53 / $42.95 / $89.01	Professional		$12.53	$42.95	$89.01
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $13.02 / $20.39	Professional	26	$9.33	$13.02	$20.39
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $27.53 / $39.27 / $67.22	Professional	TC	$27.53	$39.27	$67.22
United Facility/Professional Professional Modifier Low / Median / High Price $30.50 / $43.39 / $74.95	Professional		$30.50	$43.39	$74.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.31 / $11.40 / $18.46	Professional	26	$7.31	$11.40	$18.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.54 / $31.77 / $55.77	Professional	TC	$21.54	$31.77	$55.77