Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $140.72 / $266.26 / $3,216.78	Facility		$140.72	$266.26	$3,216.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.58 / $92.32 / $233.76	Facility	26	$72.58	$92.32	$233.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.12 / $149.80 / $340.98	Professional		$128.12	$149.80	$340.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.34 / $77.72 / $123.43	Professional	26	$51.34	$77.72	$123.43
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $63.07 / $70.36 / $89.95	Professional	52	$63.07	$70.36	$89.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.08 / $72.08 / $202.54	Professional	TC	$60.08	$72.08	$202.54
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $444.46 / $560.54 / $733.33	Facility		$444.46	$560.54	$733.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.29 / $176.85 / $288.64	Professional		$138.29	$176.85	$288.64
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.78 / $90.92 / $132.61	Professional	26	$63.78	$90.92	$132.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.61 / $81.34 / $169.76	Professional	TC	$63.61	$81.34	$169.76
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $180.73 / $181.82 / $1,709.74	Professional		$180.73	$181.82	$1,709.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $58.12 / $75.03 / $93.79	Professional	26	$58.12	$75.03	$93.79
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $98.54 / $106.79 / $201.83	Professional	TC	$98.54	$106.79	$201.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $173.33 / $369.92 / $825.00	Facility		$173.33	$369.92	$825.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.06 / $94.06 / $94.06	Facility	26	$94.06	$94.06	$94.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.60 / $235.22 / $648.88	Professional		$118.60	$235.22	$648.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.40 / $80.34 / $172.57	Professional	26	$55.40	$80.34	$172.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.35 / $142.43 / $561.41	Professional	TC	$55.35	$142.43	$561.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.86 / $168.67 / $208.03	Professional		$138.86	$168.67	$208.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $72.68 / $89.78 / $108.86	Professional	26	$72.68	$89.78	$108.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.19 / $79.43 / $97.34	Professional	TC	$66.19	$79.43	$97.34
Medcost Facility/Professional Facility Modifier Low / Median / High Price $141.30 / $244.05 / $788.25	Facility		$141.30	$244.05	$788.25
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $82.38 / $95.00 / $224.40	Facility	26	$82.38	$95.00	$224.40
Medcost Facility/Professional Professional Modifier Low / Median / High Price $75.00 / $177.00 / $395.00	Professional		$75.00	$177.00	$395.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $71.59 / $160.62 / $494.46	Facility		$71.59	$160.62	$494.46
Sentara Facility/Professional Professional Modifier Low / Median / High Price $80.02 / $220.61 / $631.50	Professional		$80.02	$220.61	$631.50
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $62.67 / $94.41 / $164.62	Professional	26	$62.67	$94.41	$164.62
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $77.92 / $143.91 / $323.54	Professional	TC	$77.92	$143.91	$323.54
United Facility/Professional Professional Modifier Low / Median / High Price $135.53 / $250.64 / $633.91	Professional		$135.53	$250.64	$633.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.99 / $83.83 / $158.44	Professional	26	$50.99	$83.83	$158.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.35 / $121.49 / $528.79	Professional	TC	$62.35	$121.49	$528.79