Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $130.84 / $232.89 / $566.16	Facility		$130.84	$232.89	$566.16
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.25 / $21.62 / $49.19	Facility	26	$19.25	$21.62	$49.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.82 / $134.71 / $222.87	Professional		$113.82	$134.71	$222.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $23.23 / $36.77	Professional	26	$11.78	$23.23	$36.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.29 / $112.26 / $182.09	Professional	TC	$96.29	$112.26	$182.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $118.17 / $165.01 / $253.48	Professional		$118.17	$165.01	$253.48
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.30 / $25.81 / $39.35	Professional	26	$18.30	$25.81	$39.35
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $101.65 / $139.18 / $219.30	Professional	TC	$101.65	$139.18	$219.30
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $134.63 / $149.58 / $285.70	Professional		$134.63	$149.58	$285.70
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $19.42 / $21.58 / $39.81	Professional	26	$19.42	$21.58	$39.81
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $115.21 / $128.01 / $236.18	Professional	TC	$115.21	$128.01	$236.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.68 / $496.07 / $687.15	Facility		$147.68	$496.07	$687.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.75 / $26.75 / $26.75	Facility	26	$26.75	$26.75	$26.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $140.86 / $204.32 / $337.99	Professional		$140.86	$204.32	$337.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.99 / $24.84 / $48.17	Professional	26	$13.99	$24.84	$48.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.01 / $179.48 / $291.13	Professional	TC	$123.01	$179.48	$291.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $137.69 / $165.08 / $247.62	Professional		$137.69	$165.08	$247.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.38 / $23.98 / $35.97	Professional	26	$20.38	$23.98	$35.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $116.27 / $141.10 / $211.65	Professional	TC	$116.27	$141.10	$211.65
Medcost Facility/Professional Facility Modifier Low / Median / High Price $117.70 / $165.77 / $273.64	Facility		$117.70	$165.77	$273.64
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $12.97 / $22.00 / $60.40	Facility	26	$12.97	$22.00	$60.40
Medcost Facility/Professional Professional Modifier Low / Median / High Price $20.00 / $191.00 / $309.00	Professional		$20.00	$191.00	$309.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $16.27 / $133.58 / $214.54	Facility		$16.27	$133.58	$214.54
Sentara Facility/Professional Professional Modifier Low / Median / High Price $18.35 / $153.83 / $236.00	Professional		$18.35	$153.83	$236.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $13.88 / $23.68 / $46.98	Professional	26	$13.88	$23.68	$46.98
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $109.01 / $146.13 / $211.82	Professional	TC	$109.01	$146.13	$211.82
United Facility/Professional Professional Modifier Low / Median / High Price $125.46 / $187.69 / $295.79	Professional		$125.46	$187.69	$295.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.08 / $22.00 / $38.83	Professional	26	$12.08	$22.00	$38.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.24 / $162.21 / $260.47	Professional	TC	$105.24	$162.21	$260.47