Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $281.84 / $645.65	Facility		$52.48	$281.84	$645.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.92 / $11.48 / $30.90	Facility	26	$6.92	$11.48	$30.90
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.91 / $93.33 / $776.25	Facility	TC	$22.91	$93.33	$776.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $30.20 / $91.20	Professional		$8.51	$30.20	$91.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $14.13 / $44.67	Professional	26	$7.08	$14.13	$44.67
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $16.98 / $72.44 / $162.18	Professional	50	$16.98	$72.44	$162.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $28.84 / $64.57	Professional	TC	$18.20	$28.84	$64.57
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $131.83 / $165.96	Facility		$109.65	$131.83	$165.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $40.74 / $66.07	Professional		$28.84	$40.74	$66.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $10.00 / $15.14	Professional	26	$7.24	$10.00	$15.14
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $43.65 / $61.66 / $100.00	Professional	50	$43.65	$61.66	$100.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.20 / $46.77	Professional	TC	$20.89	$30.20	$46.77
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $8.13 / $32.36 / $89.13	Professional		$8.13	$32.36	$89.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $8.51 / $12.30	Professional	26	$7.41	$8.51	$12.30
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $25.12 / $38.90	Professional	TC	$23.44	$25.12	$38.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $95.50 / $524.81	Facility		$48.98	$95.50	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.59	Facility	26	$1.86	$8.71	$12.59
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $5.62 / $26.30 / $37.15	Facility	TC	$5.62	$26.30	$37.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $35.48 / $64.57	Professional		$23.99	$35.48	$64.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $10.00 / $17.38	Professional	26	$6.17	$10.00	$17.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $24.55 / $50.12	Professional	TC	$17.78	$24.55	$50.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $37.15 / $45.71	Professional		$30.90	$37.15	$45.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $8.71 / $11.22	Professional	26	$7.08	$8.71	$11.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $28.18 / $35.48	Professional	TC	$23.44	$28.18	$35.48
Medcost Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $45.71 / $67.61	Professional		$36.31	$45.71	$67.61
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $15.49 / $16.98	Professional	26	$12.30	$15.49	$16.98
Medcost Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $39.81 / $61.66	Facility		$26.30	$39.81	$61.66
Medcost Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $30.20 / $51.29	Professional		$30.20	$30.20	$51.29
Sentara Facility/Professional Facility Modifier Low / Median / High Price $9.33 / $27.54 / $74.13	Facility		$9.33	$27.54	$74.13
Sentara Facility/Professional Professional Modifier Low / Median / High Price $10.23 / $32.36 / $141.25	Professional		$10.23	$32.36	$141.25
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.47 / $17.38	Professional	26	$7.94	$10.47	$17.38
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $27.54 / $52.48	Professional	TC	$20.42	$27.54	$52.48
United Facility/Professional Facility Modifier Low / Median / High Price $8.51 / $26.30 / $186.21	Facility		$8.51	$26.30	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $33.88 / $56.23	Professional		$21.88	$33.88	$56.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $9.12 / $16.22	Professional	26	$6.17	$9.12	$16.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $23.44 / $42.66	Professional	TC	$15.49	$23.44	$42.66