Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $136.78 / $295.99 / $658.27	Facility		$136.78	$295.99	$658.27
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.12 / $34.20 / $85.67	Facility	26	$20.12	$34.20	$85.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $122.46 / $144.41 / $275.99	Professional		$122.46	$144.41	$275.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.12 / $23.60 / $41.31	Professional	26	$20.12	$23.60	$41.31
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.14 / $65.36 / $78.16	Professional	52	$60.14	$65.36	$78.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.37 / $118.68 / $240.56	Professional	TC	$102.37	$118.68	$240.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.16 / $153.66 / $213.37	Professional		$120.16	$153.66	$213.37
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.66 / $24.97 / $34.92	Professional	26	$19.66	$24.97	$34.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.49 / $128.51 / $177.37	Professional	TC	$100.49	$128.51	$177.37
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $164.07 / $164.07 / $592.23	Professional		$164.07	$164.07	$592.23
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $22.35 / $22.35 / $42.24	Professional	26	$22.35	$22.35	$42.24
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $141.72 / $141.72 / $267.85	Professional	TC	$141.72	$141.72	$267.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $268.11 / $428.97 / $750.00	Facility		$268.11	$428.97	$750.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.72 / $24.72 / $24.72	Facility	26	$24.72	$24.72	$24.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.44 / $185.02 / $295.58	Professional		$127.44	$185.02	$295.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.78 / $29.01 / $49.95	Professional	26	$20.78	$29.01	$49.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $106.13 / $156.32 / $257.29	Professional	TC	$106.13	$156.32	$257.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.48 / $155.36 / $186.73	Professional		$123.48	$155.36	$186.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.95 / $23.93 / $29.51	Professional	26	$18.95	$23.93	$29.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $103.54 / $131.94 / $157.99	Professional	TC	$103.54	$131.94	$157.99
Medcost Facility/Professional Facility Modifier Low / Median / High Price $130.71 / $185.96 / $283.36	Facility		$130.71	$185.96	$283.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $23.63 / $39.00 / $66.45	Facility	26	$23.63	$39.00	$66.45
Medcost Facility/Professional Professional Modifier Low / Median / High Price $29.00 / $169.00 / $281.00	Professional		$29.00	$169.00	$281.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $25.90 / $148.08 / $268.45	Facility		$25.90	$148.08	$268.45
Sentara Facility/Professional Professional Modifier Low / Median / High Price $29.39 / $173.32 / $310.61	Professional		$29.39	$173.32	$310.61
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $21.79 / $29.94 / $49.11	Professional	26	$21.79	$29.94	$49.11
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $122.25 / $163.09 / $253.54	Professional	TC	$122.25	$163.09	$253.54
United Facility/Professional Professional Modifier Low / Median / High Price $113.51 / $175.12 / $284.33	Professional		$113.51	$175.12	$284.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.01 / $26.60 / $44.58	Professional	26	$18.01	$26.60	$44.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $94.25 / $148.36 / $243.79	Professional	TC	$94.25	$148.36	$243.79