Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $426.58 / $912.01	Facility		$83.18	$426.58	$912.01
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $41.69 / $208.93	Facility	26	$28.84	$41.69	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $95.50 / $309.03	Professional		$51.29	$95.50	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $57.54 / $144.54	Professional	26	$28.84	$57.54	$144.54
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $53.70 / $154.88 / $630.96	Professional	50	$53.70	$154.88	$630.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $57.54 / $134.90	Professional	TC	$43.65	$57.54	$134.90
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $346.74 / $436.52	Facility		$295.12	$346.74	$436.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $114.82 / $169.82	Professional		$83.18	$114.82	$169.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $42.66 / $61.66	Professional	26	$30.90	$42.66	$61.66
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $123.03 / $173.78 / $257.04	Professional	50	$123.03	$173.78	$257.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $70.79 / $104.71	Professional	TC	$50.12	$70.79	$104.71
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $95.50 / $208.93	Professional		$60.26	$95.50	$208.93
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $34.67 / $41.69	Professional	26	$30.90	$34.67	$41.69
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $54.95 / $70.79	Professional	TC	$51.29	$54.95	$70.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $234.42 / $524.81	Facility		$128.82	$234.42	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $107.15 / $186.21	Professional		$69.18	$107.15	$186.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $40.74 / $70.79	Professional	26	$26.30	$40.74	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $66.07 / $120.23	Professional	TC	$42.66	$66.07	$120.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $95.50 / $120.23	Professional		$75.86	$95.50	$120.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $33.88 / $43.65	Professional	26	$27.54	$33.88	$43.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $61.66 / $75.86	Professional	TC	$48.98	$61.66	$75.86
Medcost Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Professional		$190.55	$190.55	$190.55
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $69.18 / $69.18	Professional	26	$69.18	$69.18	$69.18
Medcost Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $109.65 / $165.96	Facility		$74.13	$109.65	$165.96
Medcost Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $61.66 / $138.04	Professional		$61.66	$61.66	$138.04
Sentara Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $74.13 / $165.96	Facility		$38.90	$74.13	$165.96
Sentara Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $95.50 / $223.87	Professional		$40.74	$95.50	$223.87
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $44.67 / $69.18	Professional	26	$34.67	$44.67	$69.18
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $69.18 / $107.15	Professional	TC	$53.70	$69.18	$107.15
United Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $89.13 / $186.21	Facility		$45.71	$89.13	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $89.13 / $154.88	Professional		$67.61	$89.13	$154.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $34.67 / $58.88	Professional	26	$25.70	$34.67	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $57.54 / $97.72	Professional	TC	$42.66	$57.54	$97.72