Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $59.99 / $200.66 / $468.94	Facility		$59.99	$200.66	$468.94
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.09 / $27.09 / $76.09	Facility	26	$27.09	$27.09	$76.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.78 / $63.15 / $132.18	Professional		$47.78	$63.15	$132.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.75 / $32.34 / $56.38	Professional	26	$26.75	$32.34	$56.38
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $330.55 / $330.55 / $330.55	Professional	50	$330.55	$330.55	$330.55
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $21.85 / $29.82 / $39.68	Professional	52	$21.85	$29.82	$39.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.69 / $32.90 / $72.48	Professional	TC	$17.69	$32.90	$72.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.99 / $56.79 / $82.01	Professional		$43.99	$56.79	$82.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.03 / $34.97 / $48.27	Professional	26	$27.03	$34.97	$48.27
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $65.98 / $83.11 / $122.54	Professional	50	$65.98	$83.11	$122.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $20.94 / $35.31	Professional	TC	$16.22	$20.94	$35.31
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $48.15 / $53.50 / $279.47	Professional		$48.15	$53.50	$279.47
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $24.67 / $27.41 / $51.80	Professional	26	$24.67	$27.41	$51.80
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $20.62 / $25.22 / $47.67	Professional	TC	$20.62	$25.22	$47.67
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.57 / $52.57 / $52.57	Facility		$52.57	$52.57	$52.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.50 / $94.15 / $140.29	Professional		$45.50	$94.15	$140.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.15 / $38.65 / $68.15	Professional	26	$26.15	$38.65	$68.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.48 / $56.24 / $83.16	Professional	TC	$16.48	$56.24	$83.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.19 / $54.59 / $66.67	Professional		$44.19	$54.59	$66.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.16 / $34.28 / $42.28	Professional	26	$27.16	$34.28	$42.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $16.48 / $21.04 / $25.19	Professional	TC	$16.48	$21.04	$25.19
Medcost Facility/Professional Facility Modifier Low / Median / High Price $54.67 / $86.00 / $136.62	Facility		$54.67	$86.00	$136.62
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $29.00 / $30.26 / $78.64	Facility	26	$29.00	$30.26	$78.64
Medcost Facility/Professional Professional Modifier Low / Median / High Price $39.00 / $73.00 / $125.00	Professional		$39.00	$73.00	$125.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $31.55 / $60.31 / $117.21	Facility		$31.55	$60.31	$117.21
Sentara Facility/Professional Professional Modifier Low / Median / High Price $35.35 / $81.00 / $132.65	Professional		$35.35	$81.00	$132.65
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $41.60 / $66.59	Professional	26	$31.62	$41.60	$66.59
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $24.62 / $55.59 / $84.97	Professional	TC	$24.62	$55.59	$84.97
United Facility/Professional Professional Modifier Low / Median / High Price $50.82 / $83.50 / $138.27	Professional		$50.82	$83.50	$138.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.38 / $36.15 / $60.27	Professional	26	$23.38	$36.15	$60.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.15 / $42.66 / $81.66	Professional	TC	$25.15	$42.66	$81.66