Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.94 / $531.70 / $984.61	Facility		$97.94	$531.70	$984.61
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.08 / $52.83 / $99.64	Facility	26	$31.08	$52.83	$99.64
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $73.40 / $680.47 / $748.25	Facility	TC	$73.40	$680.47	$748.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.00 / $104.47 / $212.96	Professional		$96.00	$104.47	$212.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.66 / $33.68 / $73.64	Professional	26	$30.66	$33.68	$73.64
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.66 / $50.39 / $66.59	Professional	52	$44.66	$50.39	$66.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.42 / $73.40 / $137.19	Professional	TC	$64.42	$73.40	$137.19
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $328.21 / $413.93 / $541.52	Facility		$328.21	$413.93	$541.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.88 / $125.68 / $175.18	Professional		$99.88	$125.68	$175.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.96 / $40.02 / $56.10	Professional	26	$31.96	$40.02	$56.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.91 / $85.46 / $119.11	Professional	TC	$67.91	$85.46	$119.11
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $143.32 / $143.78 / $387.56	Professional		$143.32	$143.78	$387.56
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.56 / $38.56 / $72.88	Professional	26	$38.56	$38.56	$72.88
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $104.76 / $104.76 / $198.00	Professional	TC	$104.76	$104.76	$198.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $185.84 / $298.52 / $538.25	Facility		$185.84	$298.52	$538.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $40.13 / $40.13	Facility	26	$40.13	$40.13	$40.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $82.40 / $82.40 / $82.40	Facility	TC	$82.40	$82.40	$82.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.82 / $144.35 / $258.87	Professional		$87.82	$144.35	$258.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $44.85 / $82.56	Professional	26	$28.14	$44.85	$82.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.39 / $98.69 / $176.53	Professional	TC	$60.39	$98.69	$176.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.79 / $127.32 / $156.71	Professional		$102.79	$127.32	$156.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.31 / $39.79 / $49.20	Professional	26	$31.31	$39.79	$49.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $69.56 / $88.64 / $110.10	Professional	TC	$69.56	$88.64	$110.10
Medcost Facility/Professional Facility Modifier Low / Median / High Price $100.78 / $163.13 / $228.80	Facility		$100.78	$163.13	$228.80
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $52.98 / $72.00 / $107.94	Facility	26	$52.98	$72.00	$107.94
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $114.50 / $127.52 / $212.70	Facility	TC	$114.50	$127.52	$212.70
Medcost Facility/Professional Professional Modifier Low / Median / High Price $48.00 / $120.00 / $206.00	Professional		$48.00	$120.00	$206.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $41.76 / $113.02 / $212.28	Facility		$41.76	$113.02	$212.28
Sentara Facility/Professional Professional Modifier Low / Median / High Price $47.68 / $142.68 / $265.37	Professional		$47.68	$142.68	$265.37
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $37.18 / $49.49 / $78.53	Professional	26	$37.18	$49.49	$78.53
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $77.59 / $115.03 / $174.23	Professional	TC	$77.59	$115.03	$174.23
United Facility/Professional Facility Modifier Low / Median / High Price $78.22 / $250.18 / $250.18	Facility		$78.22	$250.18	$250.18
United Facility/Professional Professional Modifier Low / Median / High Price $90.22 / $137.04 / $197.45	Professional		$90.22	$137.04	$197.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.60 / $40.97 / $60.20	Professional	26	$26.60	$40.97	$60.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.72 / $92.23 / $148.29	Professional	TC	$60.72	$92.23	$148.29