Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $177.83 / $501.19	Facility		$53.70	$177.83	$501.19
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.76 / $10.96 / $29.51	Facility	26	$7.76	$10.96	$29.51
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $20.89 / $288.40 / $512.86	Facility	TC	$20.89	$288.40	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $39.81 / $100.00	Professional		$23.99	$39.81	$100.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $11.22 / $36.31	Professional	26	$7.76	$11.22	$36.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $24.55 / $53.70	Professional	TC	$15.85	$24.55	$53.70
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $123.03 / $154.88	Facility		$104.71	$123.03	$154.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $39.81 / $60.26	Professional		$27.54	$39.81	$60.26
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 TC Low / Median / High Price $19.05 / $28.18 / $42.66	Professional	TC	$19.05	$28.18	$42.66
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $33.88 / $128.82	Professional		$22.39	$33.88	$128.82
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $9.33 / $14.13	Professional	26	$8.32	$9.33	$14.13
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $24.55 / $37.15	Professional	TC	$24.55	$24.55	$37.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $85.11 / $524.81	Facility		$46.77	$85.11	$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 $5.01 / $23.44 / $33.11	Facility	TC	$5.01	$23.44	$33.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $35.48 / $61.66	Professional		$22.91	$35.48	$61.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $10.96 / $19.05	Professional	26	$6.76	$10.96	$19.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $22.91 / $44.67	Professional	TC	$15.85	$22.91	$44.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $34.67 / $42.66	Professional		$28.84	$34.67	$42.66
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 $20.42 / $25.12 / $30.90	Professional	TC	$20.42	$25.12	$30.90
Medcost Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $64.57	Professional		$64.57	$64.57	$64.57
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 $24.55 / $35.48 / $56.23	Facility		$24.55	$35.48	$56.23
Medcost Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $23.99 / $48.98	Professional		$23.99	$23.99	$48.98
Sentara Facility/Professional Facility Modifier Low / Median / High Price $10.72 / $25.12 / $60.26	Facility		$10.72	$25.12	$60.26
Sentara Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $30.90 / $97.72	Professional		$11.22	$30.90	$97.72
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $11.48 / $19.50	Professional	26	$9.12	$11.48	$19.50
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $25.12 / $45.71	Professional	TC	$18.20	$25.12	$45.71
United Facility/Professional Facility Modifier Low / Median / High Price $9.12 / $24.55 / $186.21	Facility		$9.12	$24.55	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $32.36 / $54.95	Professional		$21.88	$32.36	$54.95
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 $14.45 / $22.39 / $38.02	Professional	TC	$14.45	$22.39	$38.02