Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $399.77 / $3,633.00 / $8,920.00	Facility		$399.77	$3,633.00	$8,920.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.59 / $142.63 / $340.85	Facility	26	$131.59	$142.63	$340.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.30 / $439.96 / $783.12	Professional		$370.30	$439.96	$783.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.43 / $142.63 / $256.67	Professional	26	$128.43	$142.63	$256.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $237.40 / $286.94 / $524.22	Professional	TC	$237.40	$286.94	$524.22
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $349.60 / $452.34 / $620.38	Professional		$349.60	$452.34	$620.38
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $113.71 / $145.41 / $199.42	Professional	26	$113.71	$145.41	$199.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $237.22 / $306.93 / $420.95	Professional	TC	$237.22	$306.93	$420.95
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $467.45 / $688.35 / $1,024.79	Professional		$467.45	$688.35	$1,024.79
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $142.09 / $166.10 / $289.19	Professional	26	$142.09	$166.10	$289.19
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $325.36 / $404.97 / $705.08	Professional	TC	$325.36	$404.97	$705.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $350.19 / $477.94 / $937.44	Professional		$350.19	$477.94	$937.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $127.33 / $170.66 / $315.52	Professional	26	$127.33	$170.66	$315.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.48 / $305.66 / $615.79	Professional	TC	$218.48	$305.66	$615.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $341.64 / $409.97 / $505.63	Professional		$341.64	$409.97	$505.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $118.11 / $141.72 / $174.80	Professional	26	$118.11	$141.72	$174.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.54 / $271.02 / $338.79	Professional	TC	$223.54	$271.02	$338.79
Medcost Facility/Professional Facility Modifier Low / Median / High Price $399.77 / $476.61 / $674.60	Facility		$399.77	$476.61	$674.60
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $168.53 / $197.60 / $259.06	Facility	26	$168.53	$197.60	$259.06
Medcost Facility/Professional Professional Modifier Low / Median / High Price $162.00 / $307.00 / $613.41	Professional		$162.00	$307.00	$613.41
Sentara Facility/Professional Facility Modifier Low / Median / High Price $146.63 / $304.24 / $719.12	Facility		$146.63	$304.24	$719.12
Sentara Facility/Professional Professional Modifier Low / Median / High Price $155.44 / $398.21 / $955.46	Professional		$155.44	$398.21	$955.46
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $135.69 / $167.96 / $279.62	Professional	26	$135.69	$167.96	$279.62
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $205.09 / $305.77 / $600.14	Professional	TC	$205.09	$305.77	$600.14
United Facility/Professional Facility Modifier Low / Median / High Price $1,066.00 / $1,893.00 / $3,765.00	Facility		$1,066.00	$1,893.00	$3,765.00
United Facility/Professional Professional Modifier Low / Median / High Price $305.26 / $473.26 / $805.11	Professional		$305.26	$473.26	$805.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $105.44 / $173.73 / $278.94	Professional	26	$105.44	$173.73	$278.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $199.01 / $283.14 / $515.80	Professional	TC	$199.01	$283.14	$515.80