Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.77 / $582.84 / $1,404.48	Facility		$104.77	$582.84	$1,404.48
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.07 / $57.91 / $116.82	Facility	26	$34.07	$57.91	$116.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.63 / $112.07 / $210.69	Professional		$103.63	$112.07	$210.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.28 / $36.77 / $75.84	Professional	26	$33.28	$36.77	$75.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.04 / $78.00 / $146.22	Professional	TC	$69.04	$78.00	$146.22
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $351.60 / $443.42 / $580.10	Facility		$351.60	$443.42	$580.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.25 / $134.96 / $188.11	Professional		$107.25	$134.96	$188.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.72 / $43.63 / $61.28	Professional	26	$34.72	$43.63	$61.28
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.53 / $91.26 / $127.20	Professional	TC	$72.53	$91.26	$127.20
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $146.77 / $146.77 / $400.43	Professional		$146.77	$146.77	$400.43
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $42.29 / $42.29 / $79.93	Professional	26	$42.29	$42.29	$79.93
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $104.48 / $104.48 / $197.47	Professional	TC	$104.48	$104.48	$197.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $198.27 / $317.82 / $572.07	Facility		$198.27	$317.82	$572.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.62 / $43.62 / $43.62	Facility	26	$43.62	$43.62	$43.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.66 / $151.22 / $279.16	Professional		$93.66	$151.22	$279.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.63 / $48.68 / $91.96	Professional	26	$30.63	$48.68	$91.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.14 / $104.15 / $187.95	Professional	TC	$63.14	$104.15	$187.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $110.16 / $136.31 / $168.11	Professional		$110.16	$136.31	$168.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.33 / $43.62 / $53.96	Professional	26	$34.33	$43.62	$53.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.70 / $93.91 / $117.01	Professional	TC	$73.70	$93.91	$117.01
Medcost Facility/Professional Facility Modifier Low / Median / High Price $108.71 / $172.85 / $231.36	Facility		$108.71	$172.85	$231.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $57.69 / $82.00 / $119.13	Facility	26	$57.69	$82.00	$119.13
Medcost Facility/Professional Professional Modifier Low / Median / High Price $52.85 / $123.00 / $216.00	Professional		$52.85	$123.00	$216.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $45.70 / $120.56 / $228.48	Facility		$45.70	$120.56	$228.48
Sentara Facility/Professional Professional Modifier Low / Median / High Price $52.05 / $149.63 / $288.54	Professional		$52.05	$149.63	$288.54
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $41.19 / $54.20 / $86.10	Professional	26	$41.19	$54.20	$86.10
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $82.57 / $120.56 / $187.20	Professional	TC	$82.57	$120.56	$187.20
United Facility/Professional Professional Modifier Low / Median / High Price $95.77 / $138.43 / $212.66	Professional		$95.77	$138.43	$212.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.24 / $46.39 / $66.37	Professional	26	$30.24	$46.39	$66.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.25 / $92.03 / $146.29	Professional	TC	$64.25	$92.03	$146.29