Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $80.72 / $187.89 / $1,106.84	Facility		$80.72	$187.89	$1,106.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.73 / $24.52 / $48.65	Facility	26	$13.73	$24.52	$48.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.54 / $93.54 / $173.18	Professional		$70.54	$93.54	$173.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.48 / $14.96 / $29.39	Professional	26	$12.48	$14.96	$29.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.13 / $79.55 / $141.68	Professional	TC	$60.13	$79.55	$141.68
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $311.33 / $392.64 / $513.66	Facility		$311.33	$392.64	$513.66
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.83 / $116.24 / $170.27	Professional		$77.83	$116.24	$170.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.83 / $18.00 / $26.44	Professional	26	$13.83	$18.00	$26.44
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.58 / $99.31 / $145.16	Professional	TC	$69.58	$99.31	$145.16
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $95.84 / $110.49 / $243.38	Professional		$95.84	$110.49	$243.38
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $17.05 / $21.67	Professional	26	$17.05	$17.05	$21.67
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $78.78 / $93.43 / $116.79	Professional	TC	$78.78	$93.43	$116.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $178.24 / $313.52 / $750.00	Facility		$178.24	$313.52	$750.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.75 / $17.75 / $17.75	Facility	26	$17.75	$17.75	$17.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.68 / $107.50 / $209.56	Professional		$76.68	$107.50	$209.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.53 / $20.50 / $35.02	Professional	26	$12.53	$20.50	$35.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.59 / $87.59 / $180.23	Professional	TC	$63.59	$87.59	$180.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $98.40 / $118.08 / $144.69	Professional		$98.40	$118.08	$144.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.85 / $17.10 / $20.59	Professional	26	$13.85	$17.10	$20.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $84.55 / $101.46 / $124.34	Professional	TC	$84.55	$101.46	$124.34
Medcost Facility/Professional Facility Modifier Low / Median / High Price $83.06 / $122.00 / $176.10	Facility		$83.06	$122.00	$176.10
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $24.56 / $34.54 / $53.93	Facility	26	$24.56	$34.54	$53.93
Medcost Facility/Professional Professional Modifier Low / Median / High Price $21.00 / $100.62 / $158.52	Professional		$21.00	$100.62	$158.52
Sentara Facility/Professional Facility Modifier Low / Median / High Price $19.75 / $93.22 / $183.36	Facility		$19.75	$93.22	$183.36
Sentara Facility/Professional Professional Modifier Low / Median / High Price $22.45 / $101.22 / $210.47	Professional		$22.45	$101.22	$210.47
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $16.50 / $21.93 / $34.04	Professional	26	$16.50	$21.93	$34.04
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $77.41 / $110.00 / $189.40	Professional	TC	$77.41	$110.00	$189.40
United Facility/Professional Facility Modifier Low / Median / High Price $19.76 / $85.02 / $528.75	Facility		$19.76	$85.02	$528.75
United Facility/Professional Professional Modifier Low / Median / High Price $74.39 / $107.65 / $178.25	Professional		$74.39	$107.65	$178.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.77 / $19.84 / $33.33	Professional	26	$12.77	$19.84	$33.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.06 / $83.54 / $148.12	Professional	TC	$57.06	$83.54	$148.12