Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $179.02 / $486.13 / $907.39	Facility		$179.02	$486.13	$907.39
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.11 / $70.37 / $106.42	Facility	26	$45.11	$70.37	$106.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $135.30 / $179.02 / $279.27	Professional		$135.30	$179.02	$279.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.86 / $49.38 / $97.53	Professional	26	$36.86	$49.38	$97.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.60 / $133.91 / $208.40	Professional	TC	$96.60	$133.91	$208.40
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,997.00 / $2,574.00 / $2,774.00	Facility		$1,997.00	$2,574.00	$2,774.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $124.53 / $160.66 / $242.91	Professional		$124.53	$160.66	$242.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.65 / $45.68 / $76.09	Professional	26	$35.65	$45.68	$76.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.79 / $114.76 / $180.89	Professional	TC	$87.79	$114.76	$180.89
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $173.83 / $185.48 / $361.69	Professional		$173.83	$185.48	$361.69
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $46.40 / $48.35 / $94.28	Professional	26	$46.40	$48.35	$94.28
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $127.44 / $137.13 / $267.39	Professional	TC	$127.44	$137.13	$267.39
Cigna Facility/Professional Facility Modifier Low / Median / High Price $122.75 / $265.89 / $307.55	Facility		$122.75	$265.89	$307.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $130.31 / $243.61 / $403.76	Professional		$130.31	$243.61	$403.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $68.04 / $104.13	Professional	26	$37.79	$68.04	$104.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.34 / $174.84 / $301.61	Professional	TC	$93.34	$174.84	$301.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $122.99 / $147.19 / $188.10	Professional		$122.99	$147.19	$188.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.52 / $42.64 / $52.79	Professional	26	$34.52	$42.64	$52.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $88.41 / $104.09 / $135.32	Professional	TC	$88.41	$104.09	$135.32
Medcost Facility/Professional Facility Modifier Low / Median / High Price $145.51 / $196.08 / $306.39	Facility		$145.51	$196.08	$306.39
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $67.66 / $86.08 / $111.41	Facility	26	$67.66	$86.08	$111.41
Medcost Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $167.00 / $267.00	Professional		$65.00	$167.00	$267.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $57.25 / $165.73 / $290.77	Facility		$57.25	$165.73	$290.77
Sentara Facility/Professional Professional Modifier Low / Median / High Price $63.54 / $206.89 / $349.99	Professional		$63.54	$206.89	$349.99
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $46.20 / $65.80 / $95.06	Professional	26	$46.20	$65.80	$95.06
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $127.74 / $180.14 / $280.27	Professional	TC	$127.74	$180.14	$280.27
United Facility/Professional Professional Modifier Low / Median / High Price $150.77 / $228.87 / $375.23	Professional		$150.77	$228.87	$375.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.09 / $64.87 / $100.43	Professional	26	$35.09	$64.87	$100.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.89 / $177.38 / $283.70	Professional	TC	$109.89	$177.38	$283.70