Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.88 / $75.64 / $215.31	Facility		$70.88	$75.64	$215.31
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.82 / $42.45 / $101.43	Facility	26	$38.82	$42.45	$101.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.55 / $80.18 / $253.00	Professional		$62.55	$80.18	$253.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.18 / $47.19 / $96.47	Professional	26	$36.18	$47.19	$96.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.98 / $35.09 / $156.12	Professional	TC	$26.98	$35.09	$156.12
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.01 / $75.84 / $158.28	Professional		$60.01	$75.84	$158.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.01 / $42.84 / $74.22	Professional	26	$34.01	$42.84	$74.22
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.57 / $33.01 / $68.88	Professional	TC	$25.57	$33.01	$68.88
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $76.81 / $88.33 / $477.39	Professional		$76.81	$88.33	$477.39
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $44.16 / $86.11	Professional	26	$41.81	$44.16	$86.11
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $34.99 / $36.40 / $70.98	Professional	TC	$34.99	$36.40	$70.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.87 / $135.32 / $297.93	Professional		$67.87	$135.32	$297.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.39 / $71.91 / $120.72	Professional	26	$37.39	$71.91	$120.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.25 / $57.70 / $176.71	Professional	TC	$29.25	$57.70	$176.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $60.10 / $73.23 / $91.91	Professional		$60.10	$73.23	$91.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.90 / $40.65 / $50.32	Professional	26	$32.90	$40.65	$50.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.19 / $31.99 / $41.59	Professional	TC	$27.19	$31.99	$41.59
Medcost Facility/Professional Facility Modifier Low / Median / High Price $62.91 / $95.56 / $305.32	Facility		$62.91	$95.56	$305.32
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $66.06 / $104.65 / $122.72	Facility	26	$66.06	$104.65	$122.72
Medcost Facility/Professional Professional Modifier Low / Median / High Price $41.18 / $97.23 / $295.00	Professional		$41.18	$97.23	$295.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $39.33 / $93.89 / $251.45	Facility		$39.33	$93.89	$251.45
Sentara Facility/Professional Professional Modifier Low / Median / High Price $48.24 / $125.75 / $307.43	Professional		$48.24	$125.75	$307.43
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $40.81 / $77.63 / $110.67	Professional	26	$40.81	$77.63	$110.67
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $31.54 / $56.83 / $169.13	Professional	TC	$31.54	$56.83	$169.13
United Facility/Professional Facility Modifier Low / Median / High Price $231.00 / $1,045.00 / $2,364.00	Facility		$231.00	$1,045.00	$2,364.00
United Facility/Professional Professional Modifier Low / Median / High Price $60.10 / $123.05 / $290.48	Professional		$60.10	$123.05	$290.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.99 / $65.97 / $114.55	Professional	26	$32.99	$65.97	$114.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.11 / $54.73 / $200.34	Professional	TC	$27.11	$54.73	$200.34