Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $221.87 / $3,633.00 / $8,294.00	Facility		$221.87	$3,633.00	$8,294.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.70 / $45.57 / $108.93	Facility	26	$41.70	$45.57	$108.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.68 / $194.00 / $340.72	Professional		$152.68	$194.00	$340.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.70 / $45.57 / $81.73	Professional	26	$41.70	$45.57	$81.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.87 / $135.68 / $224.16	Professional	TC	$108.87	$135.68	$224.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $172.21 / $222.83 / $305.61	Professional		$172.21	$222.83	$305.61
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.95 / $45.98 / $63.06	Professional	26	$35.95	$45.98	$63.06
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $136.68 / $176.85 / $242.54	Professional	TC	$136.68	$176.85	$242.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $232.39 / $404.18 / $1,162.95	Professional		$232.39	$404.18	$1,162.95
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $44.91 / $52.62 / $91.61	Professional	26	$44.91	$52.62	$91.61
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $187.48 / $239.43 / $416.87	Professional	TC	$187.48	$239.43	$416.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $132.40 / $240.80 / $436.08	Professional		$132.40	$240.80	$436.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.90 / $58.26 / $110.90	Professional	26	$39.90	$58.26	$110.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.24 / $183.95 / $326.33	Professional	TC	$89.24	$183.95	$326.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.46 / $190.15 / $235.59	Professional		$158.46	$190.15	$235.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.19 / $44.63 / $55.04	Professional	26	$37.19	$44.63	$55.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $121.27 / $146.90 / $183.63	Professional	TC	$121.27	$146.90	$183.63
Medcost Facility/Professional Facility Modifier Low / Median / High Price $154.63 / $213.57 / $441.43	Facility		$154.63	$213.57	$441.43
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $57.25 / $70.83 / $114.28	Facility	26	$57.25	$70.83	$114.28
Medcost Facility/Professional Professional Modifier Low / Median / High Price $52.00 / $138.00 / $272.00	Professional		$52.00	$138.00	$272.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $49.22 / $142.10 / $383.09	Facility		$49.22	$142.10	$383.09
Sentara Facility/Professional Professional Modifier Low / Median / High Price $59.76 / $193.74 / $488.24	Professional		$59.76	$193.74	$488.24
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $43.18 / $56.61 / $96.42	Professional	26	$43.18	$56.61	$96.42
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $89.51 / $185.55 / $330.72	Professional	TC	$89.51	$185.55	$330.72
United Facility/Professional Facility Modifier Low / Median / High Price $296.00 / $1,045.00 / $2,364.00	Facility		$296.00	$1,045.00	$2,364.00
United Facility/Professional Professional Modifier Low / Median / High Price $134.81 / $212.26 / $386.29	Professional		$134.81	$212.26	$386.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.74 / $61.76 / $100.74	Professional	26	$34.74	$61.76	$100.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $99.61 / $158.30 / $289.11	Professional	TC	$99.61	$158.30	$289.11