Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.21 / $522.48 / $970.05	Facility		$97.21	$522.48	$970.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.14 / $42.73 / $106.82	Facility	26	$25.14	$42.73	$106.82
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $101.26 / $680.47 / $885.37	Facility	TC	$101.26	$680.47	$885.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.86 / $92.01 / $176.02	Professional		$77.86	$92.01	$176.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.14 / $27.75 / $59.13	Professional	26	$25.14	$27.75	$59.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.27 / $59.57 / $116.75	Professional	TC	$52.27	$59.57	$116.75
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $264.42 / $333.47 / $436.26	Facility		$264.42	$333.47	$436.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.20 / $100.92 / $140.66	Professional		$80.20	$100.92	$140.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.20 / $31.66 / $44.25	Professional	26	$25.20	$31.66	$44.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.01 / $69.22 / $96.48	Professional	TC	$55.01	$69.22	$96.48
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $116.01 / $118.37 / $288.92	Professional		$116.01	$118.37	$288.92
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.78 / $30.78 / $58.17	Professional	26	$30.78	$30.78	$58.17
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $85.22 / $87.58 / $165.53	Professional	TC	$85.22	$87.58	$165.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $150.49 / $241.81 / $439.21	Facility		$150.49	$241.81	$439.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.67 / $31.67 / $31.67	Facility	26	$31.67	$31.67	$31.67
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $66.73 / $66.73 / $66.73	Facility	TC	$66.73	$66.73	$66.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.38 / $114.76 / $207.68	Professional		$70.38	$114.76	$207.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.23 / $35.84 / $65.84	Professional	26	$22.23	$35.84	$65.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.94 / $79.05 / $141.53	Professional	TC	$47.94	$79.05	$141.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $82.80 / $102.52 / $127.07	Professional		$82.80	$102.52	$127.07
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.99 / $31.75 / $39.28	Professional	26	$24.99	$31.75	$39.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.26 / $71.65 / $89.36	Professional	TC	$56.26	$71.65	$89.36
Medcost Facility/Professional Facility Modifier Low / Median / High Price $81.13 / $128.76 / $172.56	Facility		$81.13	$128.76	$172.56
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $42.24 / $58.00 / $86.16	Facility	26	$42.24	$58.00	$86.16
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $75.75 / $129.16 / $201.29	Facility	TC	$75.75	$129.16	$201.29
Medcost Facility/Professional Professional Modifier Low / Median / High Price $38.00 / $100.00 / $163.00	Professional		$38.00	$100.00	$163.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $33.09 / $91.30 / $170.95	Facility		$33.09	$91.30	$170.95
Sentara Facility/Professional Professional Modifier Low / Median / High Price $38.29 / $113.70 / $213.71	Professional		$38.29	$113.70	$213.71
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $29.79 / $39.24 / $63.37	Professional	26	$29.79	$39.24	$63.37
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $62.19 / $94.15 / $141.00	Professional	TC	$62.19	$94.15	$141.00
United Facility/Professional Facility Modifier Low / Median / High Price $180.02 / $250.18 / $250.18	Facility		$180.02	$250.18	$250.18
United Facility/Professional Professional Modifier Low / Median / High Price $71.29 / $103.18 / $157.58	Professional		$71.29	$103.18	$157.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.49 / $32.82 / $53.94	Professional	26	$21.49	$32.82	$53.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.05 / $74.64 / $112.87	Professional	TC	$49.05	$74.64	$112.87