Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $75.86 / $1,000.00	Facility		$70.79	$75.86	$1,000.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $41.69 / $64.57	Facility	26	$38.02	$41.69	$64.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $79.43 / $275.42	Professional		$47.86	$79.43	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $44.67 / $151.36	Professional	26	$33.11	$44.67	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $33.88 / $147.91	Professional	TC	$25.12	$33.88	$147.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $87.10 / $158.49	Professional		$64.57	$87.10	$158.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $48.98 / $89.13	Professional	26	$36.31	$48.98	$89.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $38.02 / $69.18	Professional	TC	$27.54	$38.02	$69.18
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $74.13 / $630.96	Professional		$40.74	$74.13	$630.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $41.69 / $63.10	Professional	26	$36.31	$41.69	$63.10
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $33.88 / $46.77	Professional	TC	$30.20	$33.88	$46.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $43.65 / $63.10	Facility	26	$9.33	$43.65	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $125.89 / $295.12	Professional		$67.61	$125.89	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $69.18 / $120.23	Professional	26	$37.15	$69.18	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $54.95 / $173.78	Professional	TC	$28.84	$54.95	$173.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $75.86 / $95.50	Professional		$60.26	$75.86	$95.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $40.74 / $52.48	Professional	26	$32.36	$40.74	$52.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $34.67 / $43.65	Professional	TC	$27.54	$34.67	$43.65
Medcost Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $323.59 / $331.13	Professional		$263.03	$323.59	$331.13
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $120.23 / $138.04	Professional	26	$112.20	$120.23	$138.04
Medcost Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $104.71 / $346.74	Facility		$64.57	$104.71	$346.74
Medcost Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $120.23	Professional		$120.23	$120.23	$120.23
Sentara Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $93.33 / $275.42	Facility		$36.31	$93.33	$275.42
Sentara Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $112.20 / $389.05	Professional		$42.66	$112.20	$389.05
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $74.13 / $125.89	Professional	26	$37.15	$74.13	$125.89
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $56.23 / $181.97	Professional	TC	$27.54	$56.23	$181.97
United Facility/Professional Facility Modifier Low / Median / High Price $223.87 / $1,148.15 / $2,398.83	Facility		$223.87	$1,148.15	$2,398.83
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $128.82 / $316.23	Professional		$60.26	$128.82	$316.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $67.61 / $117.49	Professional	26	$33.88	$67.61	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $54.95 / $199.53	Professional	TC	$26.30	$54.95	$199.53