Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $183.42 / $344.06 / $996.78	Facility		$183.42	$344.06	$996.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.15 / $59.75 / $152.28	Facility	26	$35.15	$59.75	$152.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.52 / $199.34 / $344.06	Professional		$171.52	$199.34	$344.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.25 / $41.95 / $71.79	Professional	26	$34.25	$41.95	$71.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.35 / $157.38 / $278.57	Professional	TC	$136.35	$157.38	$278.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $163.22 / $209.20 / $293.44	Professional		$163.22	$209.20	$293.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.67 / $43.63 / $60.74	Professional	26	$33.67	$43.63	$60.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $130.30 / $165.90 / $232.70	Professional	TC	$130.30	$165.90	$232.70
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $201.46 / $210.96 / $692.72	Professional		$201.46	$210.96	$692.72
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $34.86 / $34.86 / $65.90	Professional	26	$34.86	$34.86	$65.90
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $166.59 / $166.59 / $314.86	Professional	TC	$166.59	$166.59	$314.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $359.25 / $574.79 / $825.00	Facility		$359.25	$574.79	$825.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.31 / $43.31 / $43.31	Facility	26	$43.31	$43.31	$43.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $174.86 / $259.06 / $420.51	Professional		$174.86	$259.06	$420.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.71 / $45.51 / $88.51	Professional	26	$34.71	$45.51	$88.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.10 / $214.31 / $337.55	Professional	TC	$138.10	$214.31	$337.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $170.59 / $214.02 / $262.02	Professional		$170.59	$214.02	$262.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.31 / $43.03 / $53.07	Professional	26	$34.31	$43.03	$53.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.72 / $171.63 / $211.81	Professional	TC	$134.72	$171.63	$211.81
Medcost Facility/Professional Facility Modifier Low / Median / High Price $181.30 / $256.30 / $369.33	Facility		$181.30	$256.30	$369.33
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $34.42 / $55.00 / $99.58	Facility	26	$34.42	$55.00	$99.58
Medcost Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $235.00 / $374.00	Professional		$49.00	$235.00	$374.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $40.03 / $201.65 / $353.47	Facility		$40.03	$201.65	$353.47
Sentara Facility/Professional Professional Modifier Low / Median / High Price $46.11 / $231.71 / $441.87	Professional		$46.11	$231.71	$441.87
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $31.65 / $49.56 / $84.90	Professional	26	$31.65	$49.56	$84.90
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $165.13 / $217.59 / $340.35	Professional	TC	$165.13	$217.59	$340.35
United Facility/Professional Facility Modifier Low / Median / High Price $32.97 / $132.31 / $252.25	Facility		$32.97	$132.31	$252.25
United Facility/Professional Professional Modifier Low / Median / High Price $153.60 / $247.23 / $390.77	Professional		$153.60	$247.23	$390.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.76 / $44.03 / $79.06	Professional	26	$28.76	$44.03	$79.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.60 / $197.98 / $318.58	Professional	TC	$122.60	$197.98	$318.58