Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $66.84 / $154.08 / $589.67	Facility		$66.84	$154.08	$589.67
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.07 / $20.30 / $27.30	Facility	26	$17.07	$20.30	$27.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.06 / $74.84 / $150.52	Professional		$60.06	$74.84	$150.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.83 / $18.18 / $29.05	Professional	26	$14.83	$18.18	$29.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.07 / $53.41 / $126.78	Professional	TC	$42.07	$53.41	$126.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.30 / $79.39 / $127.27	Professional		$61.30	$79.39	$127.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.23 / $20.85 / $34.81	Professional	26	$16.23	$20.85	$34.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.49 / $58.16 / $97.09	Professional	TC	$44.49	$58.16	$97.09
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $80.81 / $88.89 / $225.62	Professional		$80.81	$88.89	$225.62
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $18.82 / $20.91 / $40.77	Professional	26	$18.82	$20.91	$40.77
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $59.90 / $59.90 / $116.80	Professional	TC	$59.90	$59.90	$116.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $122.75 / $320.77 / $374.64	Facility		$122.75	$320.77	$374.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.48 / $114.26 / $200.64	Professional		$64.48	$114.26	$200.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.42 / $24.90 / $43.28	Professional	26	$17.42	$24.90	$43.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.63 / $86.71 / $169.09	Professional	TC	$46.63	$86.71	$169.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.58 / $75.70 / $97.24	Professional		$63.58	$75.70	$97.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.39 / $20.23 / $25.06	Professional	26	$16.39	$20.23	$25.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.15 / $55.51 / $72.16	Professional	TC	$47.15	$55.51	$72.16
Medcost Facility/Professional Facility Modifier Low / Median / High Price $62.21 / $86.83 / $165.46	Facility		$62.21	$86.83	$165.46
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $18.52 / $24.00 / $47.46	Facility	26	$18.52	$24.00	$47.46
Medcost Facility/Professional Professional Modifier Low / Median / High Price $24.00 / $116.25 / $207.13	Professional		$24.00	$116.25	$207.13
Sentara Facility/Professional Facility Modifier Low / Median / High Price $21.16 / $80.86 / $166.71	Facility		$21.16	$80.86	$166.71
Sentara Facility/Professional Professional Modifier Low / Median / High Price $24.38 / $109.15 / $193.90	Professional		$24.38	$109.15	$193.90
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $18.78 / $25.79 / $41.23	Professional	26	$18.78	$25.79	$41.23
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $54.54 / $92.95 / $160.54	Professional	TC	$54.54	$92.95	$160.54
United Facility/Professional Professional Modifier Low / Median / High Price $58.19 / $104.28 / $163.12	Professional		$58.19	$104.28	$163.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.94 / $23.53 / $37.70	Professional	26	$14.94	$23.53	$37.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.46 / $75.08 / $128.96	Professional	TC	$42.46	$75.08	$128.96