Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $18.39 / $87.51 / $256.29	Facility		$18.39	$87.51	$256.29
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.72 / $2.72 / $7.74	Facility	26	$2.72	$2.72	$7.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.39 / $25.97 / $44.31	Professional		$18.39	$25.97	$44.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.57 / $3.58 / $5.99	Professional	26	$2.57	$3.58	$5.99
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $9.17 / $10.56 / $15.33	Professional	52	$9.17	$10.56	$15.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.68 / $22.62 / $37.39	Professional	TC	$15.68	$22.62	$37.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.24 / $27.51 / $41.26	Professional		$21.24	$27.51	$41.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $2.76 / $3.54 / $7.38	Professional	26	$2.76	$3.54	$7.38
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $31.56 / $41.26 / $61.89	Professional	50	$31.56	$41.26	$61.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.32 / $23.97 / $35.96	Professional	TC	$18.32	$23.97	$35.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $14.54 / $23.05 / $135.49	Professional		$14.54	$23.05	$135.49
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $2.04 / $2.84 / $5.37	Professional	26	$2.04	$2.84	$5.37
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $12.50 / $20.21 / $25.26	Professional	TC	$12.50	$20.21	$25.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.10 / $26.10 / $26.10	Facility		$26.10	$26.10	$26.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.41 / $3.41 / $3.41	Facility	26	$3.41	$3.41	$3.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.51 / $33.19 / $58.52	Professional		$19.51	$33.19	$58.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.84 / $4.76 / $14.56	Professional	26	$2.84	$4.76	$14.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.48 / $28.90 / $48.42	Professional	TC	$17.48	$28.90	$48.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $22.41 / $26.90 / $32.96	Professional		$22.41	$26.90	$32.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $2.75 / $3.38 / $4.13	Professional	26	$2.75	$3.38	$4.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.66 / $23.59 / $28.91	Professional	TC	$19.66	$23.59	$28.91
Medcost Facility/Professional Facility Modifier Low / Median / High Price $18.89 / $33.83 / $59.17	Facility		$18.89	$33.83	$59.17
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $3.44 / $11.00 / $12.24	Facility	26	$3.44	$11.00	$12.24
Medcost Facility/Professional Professional Modifier Low / Median / High Price $4.00 / $26.00 / $49.00	Professional		$4.00	$26.00	$49.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $4.21 / $25.83 / $48.91	Facility		$4.21	$25.83	$48.91
Sentara Facility/Professional Professional Modifier Low / Median / High Price $6.09 / $31.40 / $55.41	Professional		$6.09	$31.40	$55.41
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $3.29 / $5.05 / $9.42	Professional	26	$3.29	$5.05	$9.42
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $20.29 / $30.32 / $43.74	Professional	TC	$20.29	$30.32	$43.74
United Facility/Professional Professional Modifier Low / Median / High Price $19.79 / $31.64 / $58.76	Professional		$19.79	$31.64	$58.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $2.76 / $4.54 / $13.81	Professional	26	$2.76	$4.54	$13.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.53 / $25.17 / $46.12	Professional	TC	$17.53	$25.17	$46.12