Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $108.87 / $461.65 / $685.54	Facility		$108.87	$461.65	$685.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.92 / $30.89 / $93.87	Facility	26	$20.92	$30.89	$93.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.71 / $142.21 / $243.38	Professional		$120.71	$142.21	$243.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.48 / $25.85 / $43.86	Professional	26	$20.48	$25.85	$43.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.37 / $116.35 / $206.11	Professional	TC	$99.37	$116.35	$206.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.04 / $167.06 / $234.32	Professional		$128.04	$167.06	$234.32
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.44 / $26.29 / $36.97	Professional	26	$20.44	$26.29	$36.97
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $104.66 / $140.56 / $197.43	Professional	TC	$104.66	$140.56	$197.43
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $144.99 / $163.11 / $589.09	Professional		$144.99	$163.11	$589.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $20.74 / $20.74 / $39.20	Professional	26	$20.74	$20.74	$39.20
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $124.25 / $124.25 / $234.83	Professional	TC	$124.25	$124.25	$234.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $302.50 / $483.99 / $781.66	Facility		$302.50	$483.99	$781.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.35 / $26.35 / $26.35	Facility	26	$26.35	$26.35	$26.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.74 / $203.30 / $335.16	Professional		$138.74	$203.30	$335.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.43 / $28.58 / $54.26	Professional	26	$21.43	$28.58	$54.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $116.57 / $174.18 / $284.32	Professional	TC	$116.57	$174.18	$284.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $135.05 / $169.71 / $208.12	Professional		$135.05	$169.71	$208.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.07 / $25.51 / $31.55	Professional	26	$20.07	$25.51	$31.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $113.73 / $144.91 / $178.22	Professional	TC	$113.73	$144.91	$178.22
Medcost Facility/Professional Facility Modifier Low / Median / High Price $120.88 / $182.84 / $297.79	Facility		$120.88	$182.84	$297.79
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $20.82 / $33.00 / $63.52	Facility	26	$20.82	$33.00	$63.52
Medcost Facility/Professional Professional Modifier Low / Median / High Price $31.00 / $182.00 / $305.00	Professional		$31.00	$182.00	$305.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $24.98 / $149.40 / $258.27	Facility		$24.98	$149.40	$258.27
Sentara Facility/Professional Professional Modifier Low / Median / High Price $27.80 / $177.79 / $322.41	Professional		$27.80	$177.79	$322.41
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $19.29 / $30.49 / $51.17	Professional	26	$19.29	$30.49	$51.17
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $121.24 / $170.43 / $255.94	Professional	TC	$121.24	$170.43	$255.94
United Facility/Professional Professional Modifier Low / Median / High Price $122.42 / $194.91 / $311.19	Professional		$122.42	$194.91	$311.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.29 / $27.15 / $48.06	Professional	26	$17.29	$27.15	$48.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.51 / $169.57 / $285.63	Professional	TC	$103.51	$169.57	$285.63