Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.92 / $260.23 / $534.85	Professional		$182.92	$260.23	$534.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.96 / $74.12 / $279.36	Professional	26	$21.96	$74.12	$279.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.84 / $192.86 / $398.74	Professional	TC	$149.84	$192.86	$398.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $180.29 / $268.88 / $561.09	Professional		$180.29	$268.88	$561.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.05 / $80.05 / $202.18	Professional	26	$80.05	$80.05	$202.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.01 / $181.30 / $378.33	Professional	TC	$97.01	$181.30	$378.33
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $285.06 / $285.06 / $333.52	Professional		$285.06	$285.06	$333.52
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $91.87 / $91.87 / $122.90	Professional	26	$91.87	$91.87	$122.90
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $193.19 / $193.19 / $226.03	Professional	TC	$193.19	$193.19	$226.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.00 / $173.49 / $482.62	Professional		$111.00	$173.49	$482.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.99 / $48.31 / $157.24	Professional	26	$36.99	$48.31	$157.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.65 / $118.16 / $351.45	Professional	TC	$68.65	$118.16	$351.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $274.14 / $357.05 / $409.16	Professional		$274.14	$357.05	$409.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.14 / $98.98 / $129.68	Professional	26	$76.14	$98.98	$129.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $198.00 / $264.20 / $300.23	Professional	TC	$198.00	$264.20	$300.23
Medcost Facility/Professional Facility Modifier Low / Median / High Price $168.84 / $315.00 / $533.50	Facility		$168.84	$315.00	$533.50
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $115.00 / $165.00 / $255.00	Facility	26	$115.00	$165.00	$255.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $284.33 / $284.33 / $503.32	Facility	TC	$284.33	$284.33	$503.32
Medcost Facility/Professional Professional Modifier Low / Median / High Price $109.00 / $247.00 / $505.00	Professional		$109.00	$247.00	$505.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $100.24 / $210.17 / $476.45	Facility		$100.24	$210.17	$476.45
Sentara Facility/Professional Professional Modifier Low / Median / High Price $120.67 / $270.50 / $543.79	Professional		$120.67	$270.50	$543.79
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $85.43 / $119.07 / $180.77	Professional	26	$85.43	$119.07	$180.77
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $153.16 / $281.41 / $448.49	Professional	TC	$153.16	$281.41	$448.49
United Facility/Professional Professional Modifier Low / Median / High Price $130.24 / $261.05 / $543.38	Professional		$130.24	$261.05	$543.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.76 / $86.62 / $160.11	Professional	26	$51.76	$86.62	$160.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.75 / $191.20 / $357.87	Professional	TC	$71.75	$191.20	$357.87