Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $119.07 / $407.42 / $522.03	Facility		$119.07	$407.42	$522.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.27 / $37.86 / $95.14	Facility	26	$21.27	$37.86	$95.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.16 / $126.92 / $215.40	Professional		$109.16	$126.92	$215.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.88 / $24.71 / $41.68	Professional	26	$20.88	$24.71	$41.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.29 / $100.71 / $175.34	Professional	TC	$86.29	$100.71	$175.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.42 / $137.72 / $192.01	Professional		$107.42	$137.72	$192.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.24 / $27.31 / $37.96	Professional	26	$21.24	$27.31	$37.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $86.18 / $111.23 / $154.04	Professional	TC	$86.18	$111.23	$154.04
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $128.87 / $138.15 / $486.98	Professional		$128.87	$138.15	$486.98
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $23.37 / $23.37 / $44.17	Professional	26	$23.37	$23.37	$44.17
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $105.50 / $105.50 / $199.39	Professional	TC	$105.50	$105.50	$199.39
Cigna Facility/Professional Facility Modifier Low / Median / High Price $237.08 / $379.32 / $682.78	Facility		$237.08	$379.32	$682.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.40 / $172.40 / $276.30	Professional		$114.40	$172.40	$276.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.35 / $29.83 / $55.02	Professional	26	$22.35	$29.83	$55.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.82 / $144.19 / $225.04	Professional	TC	$91.82	$144.19	$225.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $110.86 / $138.94 / $170.11	Professional		$110.86	$138.94	$170.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.72 / $26.26 / $32.38	Professional	26	$20.72	$26.26	$32.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $88.97 / $113.34 / $139.72	Professional	TC	$88.97	$113.34	$139.72
Medcost Facility/Professional Facility Modifier Low / Median / High Price $117.81 / $166.65 / $251.10	Facility		$117.81	$166.65	$251.10
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $23.24 / $38.00 / $64.18	Facility	26	$23.24	$38.00	$64.18
Medcost Facility/Professional Professional Modifier Low / Median / High Price $31.00 / $150.00 / $258.00	Professional		$31.00	$150.00	$258.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $27.10 / $137.24 / $227.17	Facility		$27.10	$137.24	$227.17
Sentara Facility/Professional Professional Modifier Low / Median / High Price $29.71 / $155.83 / $269.24	Professional		$29.71	$155.83	$269.24
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $23.75 / $31.33 / $51.93	Professional	26	$23.75	$31.33	$51.93
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $110.84 / $149.02 / $223.05	Professional	TC	$110.84	$149.02	$223.05
United Facility/Professional Facility Modifier Low / Median / High Price $22.71 / $110.74 / $159.29	Facility		$22.71	$110.74	$159.29
United Facility/Professional Professional Modifier Low / Median / High Price $99.25 / $159.30 / $259.33	Professional		$99.25	$159.30	$259.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.76 / $28.87 / $49.55	Professional	26	$18.76	$28.87	$49.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.95 / $132.80 / $216.05	Professional	TC	$80.95	$132.80	$216.05