Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.91 / $280.50 / $673.35	Facility		$54.91	$280.50	$673.35
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.54 / $49.20 / $131.57	Facility	26	$31.54	$49.20	$131.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.94 / $54.91 / $123.60	Professional		$41.94	$54.91	$123.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.95 / $31.54 / $71.00	Professional	26	$26.95	$31.54	$71.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $225.00 / $225.00 / $225.00	Professional	50	$225.00	$225.00	$225.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.25 / $23.38 / $52.60	Professional	TC	$15.25	$23.38	$52.60
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $144.44 / $182.17 / $238.32	Facility		$144.44	$182.17	$238.32
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.25 / $56.59 / $93.56	Professional		$44.25	$56.59	$93.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.33 / $35.36 / $53.96	Professional	26	$27.33	$35.36	$53.96
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $66.38 / $84.88 / $124.15	Professional	50	$66.38	$84.88	$124.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.59 / $21.22 / $35.08	Professional	TC	$16.59	$21.22	$35.08
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $61.46 / $62.22 / $410.90	Professional		$61.46	$62.22	$410.90
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $35.76 / $35.76 / $67.59	Professional	26	$35.76	$35.76	$67.59
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $26.46 / $51.60	Professional	TC	$25.70	$26.46	$51.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.21 / $97.14 / $439.21	Facility		$46.21	$97.14	$439.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $34.29	Facility	26	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.84 / $92.17 / $144.21	Professional		$40.84	$92.17	$144.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.76 / $47.61 / $79.29	Professional	26	$24.76	$47.61	$79.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.95 / $38.83 / $75.76	Professional	TC	$14.95	$38.83	$75.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.78 / $55.31 / $67.62	Professional		$44.78	$55.31	$67.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.41 / $34.68 / $42.77	Professional	26	$27.41	$34.68	$42.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $16.80 / $21.45 / $26.17	Professional	TC	$16.80	$21.45	$26.17
Medcost Facility/Professional Facility Modifier Low / Median / High Price $44.71 / $87.80 / $192.00	Facility		$44.71	$87.80	$192.00
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $58.00 / $60.00 / $96.51	Facility	26	$58.00	$60.00	$96.51
Medcost Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $72.08 / $144.00	Professional		$45.00	$72.08	$144.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $30.33 / $60.67 / $124.12	Facility		$30.33	$60.67	$124.12
Sentara Facility/Professional Professional Modifier Low / Median / High Price $40.01 / $80.70 / $153.46	Professional		$40.01	$80.70	$153.46
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $34.84 / $56.81 / $76.69	Professional	26	$34.84	$56.81	$76.69
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $21.81 / $39.82 / $67.03	Professional	TC	$21.81	$39.82	$67.03
United Facility/Professional Facility Modifier Low / Median / High Price $78.22 / $250.18 / $250.18	Facility		$78.22	$250.18	$250.18
United Facility/Professional Professional Modifier Low / Median / High Price $42.73 / $81.27 / $163.03	Professional		$42.73	$81.27	$163.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.59 / $41.81 / $76.09	Professional	26	$25.59	$41.81	$76.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.14 / $32.47 / $85.72	Professional	TC	$17.14	$32.47	$85.72