Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $59.04 / $296.95 / $645.65	Facility		$59.04	$296.95	$645.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.32 / $11.22 / $21.82	Facility	26	$7.32	$11.22	$21.82
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.70 / $403.97 / $783.38	Facility	TC	$23.70	$403.97	$783.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.55 / $28.19 / $53.99	Professional		$16.55	$28.19	$53.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.65 / $8.13 / $24.03	Professional	26	$6.65	$8.13	$24.03
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.43 / $28.43 / $56.70	Professional	50	$28.43	$28.43	$56.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $22.83 / $41.46	Professional	TC	$17.57	$22.83	$41.46
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $96.74 / $122.00 / $159.61	Facility		$96.74	$122.00	$159.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.12 / $35.47 / $51.98	Professional		$27.12	$35.47	$51.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.91 / $9.03 / $13.32	Professional	26	$6.91	$9.03	$13.32
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $40.68 / $53.32 / $82.22	Professional	50	$40.68	$53.32	$82.22
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.44 / $26.88 / $39.29	Professional	TC	$19.44	$26.88	$39.29
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.13 / $35.79 / $88.31	Professional		$30.13	$35.79	$88.31
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $8.86 / $9.31 / $11.82	Professional	26	$8.86	$9.31	$11.82
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $20.82 / $24.31 / $30.39	Professional	TC	$20.82	$24.31	$30.39
Cigna Facility/Professional Facility Modifier Low / Median / High Price $47.17 / $88.99 / $500.00	Facility		$47.17	$88.99	$500.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $26.85 / $26.85 / $26.85	Facility	TC	$26.85	$26.85	$26.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.34 / $36.77 / $64.65	Professional		$24.34	$36.77	$64.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.27 / $10.38 / $18.23	Professional	26	$6.27	$10.38	$18.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.14 / $25.44 / $48.83	Professional	TC	$18.14	$25.44	$48.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.52 / $36.63 / $44.89	Professional		$30.52	$36.63	$44.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $6.94 / $8.57 / $10.33	Professional	26	$6.94	$8.57	$10.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.59 / $28.31 / $34.69	Professional	TC	$23.59	$28.31	$34.69
Medcost Facility/Professional Facility Modifier Low / Median / High Price $26.43 / $41.28 / $59.04	Facility		$26.43	$41.28	$59.04
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $12.29 / $15.00 / $25.08	Facility	26	$12.29	$15.00	$25.08
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $26.83 / $39.03 / $64.95	Facility	TC	$26.83	$39.03	$64.95
Medcost Facility/Professional Professional Modifier Low / Median / High Price $11.00 / $28.32 / $48.00	Professional		$11.00	$28.32	$48.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $9.85 / $28.24 / $57.09	Facility		$9.85	$28.24	$57.09
Sentara Facility/Professional Professional Modifier Low / Median / High Price $11.53 / $34.54 / $69.38	Professional		$11.53	$34.54	$69.38
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.41 / $11.44 / $17.38	Professional	26	$8.41	$11.44	$17.38
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $22.48 / $29.83 / $52.04	Professional	TC	$22.48	$29.83	$52.04
United Facility/Professional Professional Modifier Low / Median / High Price $24.29 / $36.77 / $56.64	Professional		$24.29	$36.77	$56.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.19 / $9.88 / $15.68	Professional	26	$6.19	$9.88	$15.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.25 / $26.21 / $40.83	Professional	TC	$17.25	$26.21	$40.83