Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $87.10 / $302.00	Facility	26	$52.48	$87.10	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $213.80 / $416.87	Professional		$169.82	$213.80	$416.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $60.26 / $128.82	Professional	26	$42.66	$60.26	$128.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $275.42 / $436.52	Professional		$199.53	$275.42	$436.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $75.86 / $114.82	Professional	26	$53.70	$75.86	$114.82
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $245.47 / $467.74	Professional		$63.10	$245.47	$467.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $56.23 / $95.50	Professional	26	$52.48	$56.23	$95.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $97.72	Facility	26	$14.45	$67.61	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $245.47 / $457.09	Professional		$151.36	$245.47	$457.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $63.10 / $123.03	Professional	26	$42.66	$63.10	$123.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $251.19 / $323.59	Professional		$208.93	$251.19	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $66.07 / $85.11	Professional	26	$53.70	$66.07	$85.11
Medcost Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $229.09 / $501.19	Professional		$177.83	$229.09	$501.19
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $87.10 / $128.82	Professional	26	$69.18	$87.10	$128.82
Medcost Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $371.54	Professional		$120.23	$120.23	$371.54
Sentara Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $213.80 / $602.56	Professional		$64.57	$213.80	$602.56
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $67.61 / $117.49	Professional	26	$50.12	$67.61	$117.49
United Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $223.87 / $416.87	Professional		$131.83	$223.87	$416.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $64.57 / $109.65	Professional	26	$39.81	$64.57	$109.65