Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.32 / $145.08 / $537.48	Facility		$43.32	$145.08	$537.48
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.87 / $18.87 / $53.21	Facility	26	$18.87	$18.87	$53.21
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.44 / $317.25 / $657.42	Facility	TC	$24.44	$317.25	$657.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.49 / $47.45 / $98.91	Professional		$32.49	$47.45	$98.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.00 / $23.21 / $42.46	Professional	26	$18.00	$23.21	$42.46
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.37 / $21.66 / $38.56	Professional	52	$15.37	$21.66	$38.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.02 / $24.44 / $73.34	Professional	TC	$14.02	$24.44	$73.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.68 / $43.62 / $68.89	Professional		$33.68	$43.62	$68.89
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.32 / $23.37 / $35.90	Professional	26	$18.32	$23.37	$35.90
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $50.05 / $65.43 / $102.82	Professional	50	$50.05	$65.43	$102.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $15.17 / $19.64 / $41.00	Professional	TC	$15.17	$19.64	$41.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $46.45 / $48.25 / $221.48	Professional		$46.45	$48.25	$221.48
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $16.14 / $23.59 / $32.28	Professional	26	$16.14	$23.59	$32.28
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $21.81 / $24.66 / $39.83	Professional	TC	$21.81	$24.66	$39.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.38 / $41.38 / $41.38	Facility		$41.38	$41.38	$41.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.35 / $23.35 / $23.35	Facility	26	$23.35	$23.35	$23.35
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $18.64 / $18.64 / $18.64	Facility	TC	$18.64	$18.64	$18.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.07 / $78.73 / $121.75	Professional		$34.07	$78.73	$121.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.46 / $28.68 / $48.46	Professional	26	$19.46	$28.68	$48.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.91 / $49.31 / $79.13	Professional	TC	$15.91	$49.31	$79.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $34.54 / $42.12 / $51.95	Professional		$34.54	$42.12	$51.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.50 / $22.86 / $28.04	Professional	26	$18.50	$22.86	$28.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $16.05 / $19.27 / $23.61	Professional	TC	$16.05	$19.27	$23.61
Medcost Facility/Professional Facility Modifier Low / Median / High Price $40.99 / $68.00 / $121.75	Facility		$40.99	$68.00	$121.75
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $23.00 / $23.68 / $57.53	Facility	26	$23.00	$23.68	$57.53
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $14.99 / $56.33 / $139.84	Facility	TC	$14.99	$56.33	$139.84
Medcost Facility/Professional Professional Modifier Low / Median / High Price $28.00 / $61.00 / $110.00	Professional		$28.00	$61.00	$110.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $23.66 / $46.99 / $99.94	Facility		$23.66	$46.99	$99.94
Sentara Facility/Professional Professional Modifier Low / Median / High Price $27.71 / $67.14 / $115.23	Professional		$27.71	$67.14	$115.23
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $21.22 / $30.80 / $46.15	Professional	26	$21.22	$30.80	$46.15
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $18.68 / $43.82 / $83.50	Professional	TC	$18.68	$43.82	$83.50
United Facility/Professional Professional Modifier Low / Median / High Price $39.74 / $60.05 / $110.86	Professional		$39.74	$60.05	$110.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.09 / $26.29 / $38.38	Professional	26	$17.09	$26.29	$38.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.04 / $34.22 / $71.94	Professional	TC	$20.04	$34.22	$71.94