Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.94 / $485.10 / $983.68	Facility		$102.94	$485.10	$983.68
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.28 / $39.74 / $72.36	Facility	26	$24.28	$39.74	$72.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $99.23 / $107.88 / $213.42	Professional		$99.23	$107.88	$213.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.07 / $26.71 / $56.08	Professional	26	$24.07	$26.71	$56.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $45.49 / $51.47 / $63.23	Professional	52	$45.49	$51.47	$63.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.59 / $83.60 / $159.04	Professional	TC	$74.59	$83.60	$159.04
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $334.38 / $421.71 / $551.71	Facility		$334.38	$421.71	$551.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.51 / $126.19 / $178.40	Professional		$99.51	$126.19	$178.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $30.22 / $42.58	Professional	26	$23.99	$30.22	$42.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.76 / $96.07 / $135.83	Professional	TC	$75.76	$96.07	$135.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $134.37 / $134.37 / $284.20	Professional		$134.37	$134.37	$284.20
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $29.71 / $29.71 / $56.15	Professional	26	$29.71	$29.71	$56.15
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $104.66 / $104.66 / $197.81	Professional	TC	$104.66	$104.66	$197.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $159.94 / $339.65 / $613.13	Facility		$159.94	$339.65	$613.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.47 / $30.47 / $30.47	Facility	26	$30.47	$30.47	$30.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.16 / $127.80 / $263.36	Professional		$85.16	$127.80	$263.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $33.90 / $63.46	Professional	26	$21.38	$33.90	$63.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.59 / $97.18 / $198.52	Professional	TC	$63.59	$97.18	$198.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.35 / $130.18 / $161.82	Professional		$104.35	$130.18	$161.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.12 / $30.65 / $37.84	Professional	26	$24.12	$30.65	$37.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.79 / $100.39 / $125.40	Professional	TC	$78.79	$100.39	$125.40
Medcost Facility/Professional Facility Modifier Low / Median / High Price $102.94 / $146.26 / $205.88	Facility		$102.94	$146.26	$205.88
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $39.65 / $46.00 / $81.14	Facility	26	$39.65	$46.00	$81.14
Medcost Facility/Professional Professional Modifier Low / Median / High Price $37.00 / $125.00 / $197.93	Professional		$37.00	$125.00	$197.93
Sentara Facility/Professional Facility Modifier Low / Median / High Price $31.52 / $110.63 / $217.20	Facility		$31.52	$110.63	$217.20
Sentara Facility/Professional Professional Modifier Low / Median / High Price $36.63 / $133.19 / $266.73	Professional		$36.63	$133.19	$266.73
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $28.54 / $37.45 / $61.09	Professional	26	$28.54	$37.45	$61.09
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $87.58 / $122.08 / $197.02	Professional	TC	$87.58	$122.08	$197.02
United Facility/Professional Facility Modifier Low / Median / High Price $36.90 / $143.63 / $250.18	Facility		$36.90	$143.63	$250.18
United Facility/Professional Professional Modifier Low / Median / High Price $77.65 / $115.39 / $200.31	Professional		$77.65	$115.39	$200.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.67 / $31.20 / $45.75	Professional	26	$20.67	$31.20	$45.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.36 / $88.31 / $156.41	Professional	TC	$55.36	$88.31	$156.41