Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.42 / $275.42 / $1,027.89	Facility		$54.42	$275.42	$1,027.89
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.77 / $47.65 / $88.14	Facility	26	$26.77	$47.65	$88.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.07 / $60.83 / $201.19	Professional		$50.07	$60.83	$201.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.76 / $30.80 / $63.92	Professional	26	$26.76	$30.80	$63.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.10 / $27.65 / $170.39	Professional	TC	$22.10	$27.65	$170.39
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $178.54 / $225.16 / $294.57	Facility		$178.54	$225.16	$294.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.47 / $68.18 / $113.05	Professional		$53.47	$68.18	$113.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.22 / $33.71 / $48.17	Professional	26	$27.22	$33.71	$48.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.81 / $33.40 / $55.23	Professional	TC	$25.81	$33.40	$55.23
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $63.59 / $63.59 / $485.94	Professional		$63.59	$63.59	$485.94
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $33.65 / $33.65 / $63.62	Professional	26	$33.65	$33.65	$63.62
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $29.93 / $29.93 / $58.36	Professional	TC	$29.93	$29.93	$58.36
Cigna Facility/Professional Facility Modifier Low / Median / High Price $65.84 / $118.82 / $211.65	Facility		$65.84	$118.82	$211.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.51 / $34.51 / $34.51	Facility	26	$34.51	$34.51	$34.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.38 / $93.99 / $211.64	Professional		$47.38	$93.99	$211.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.21 / $39.43 / $71.44	Professional	26	$24.21	$39.43	$71.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.29 / $44.52 / $175.58	Professional	TC	$22.29	$44.52	$175.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $55.50 / $68.55 / $83.52	Professional		$55.50	$68.55	$83.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.99 / $34.29 / $42.64	Professional	26	$26.99	$34.29	$42.64
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.62 / $35.22 / $41.93	Professional	TC	$27.62	$35.22	$41.93
Medcost Facility/Professional Facility Modifier Low / Median / High Price $51.12 / $93.31 / $270.00	Facility		$51.12	$93.31	$270.00
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $47.85 / $66.00 / $93.54	Facility	26	$47.85	$66.00	$93.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $38.82 / $69.70 / $275.00	Professional		$38.82	$69.70	$275.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $65.81 / $237.04	Facility		$33.88	$65.81	$237.04
Sentara Facility/Professional Professional Modifier Low / Median / High Price $36.71 / $109.26 / $312.80	Professional		$36.71	$109.26	$312.80
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $33.61 / $44.74 / $71.23	Professional	26	$33.61	$44.74	$71.23
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $28.29 / $53.03 / $234.57	Professional	TC	$28.29	$53.03	$234.57
United Facility/Professional Professional Modifier Low / Median / High Price $46.42 / $86.16 / $210.57	Professional		$46.42	$86.16	$210.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.23 / $36.69 / $54.93	Professional	26	$24.23	$36.69	$54.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.57 / $37.27 / $156.16	Professional	TC	$20.57	$37.27	$156.16