Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $409.19 / $1,270.97 / $3,258.67	Facility		$409.19	$1,270.97	$3,258.67
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.91 / $111.17 / $579.74	Facility	26	$62.91	$111.17	$579.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.97 / $239.34 / $416.63	Professional		$195.97	$239.34	$416.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.91 / $81.98 / $142.28	Professional	26	$62.91	$81.98	$142.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $126.53 / $152.63 / $287.93	Professional	TC	$126.53	$152.63	$287.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $183.79 / $231.48 / $347.53	Professional		$183.79	$231.48	$347.53
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.03 / $79.39 / $119.09	Professional	26	$63.03	$79.39	$119.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $120.75 / $152.09 / $230.09	Professional	TC	$120.75	$152.09	$230.09
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $220.01 / $220.01 / $883.26	Professional		$220.01	$220.01	$883.26
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $67.53 / $67.53 / $127.63	Professional	26	$67.53	$67.53	$127.63
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $152.47 / $152.47 / $288.19	Professional	TC	$152.47	$152.47	$288.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $219.59 / $412.73 / $1,348.66	Facility		$219.59	$412.73	$1,348.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.85 / $303.80 / $526.09	Professional		$202.85	$303.80	$526.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.81 / $92.56 / $180.08	Professional	26	$66.81	$92.56	$180.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $135.41 / $208.25 / $332.59	Professional	TC	$135.41	$208.25	$332.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $184.95 / $228.47 / $279.95	Professional		$184.95	$228.47	$279.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.76 / $77.20 / $95.98	Professional	26	$60.76	$77.20	$95.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.41 / $153.41 / $190.09	Professional	TC	$120.41	$153.41	$190.09
Medcost Facility/Professional Facility Modifier Low / Median / High Price $195.98 / $280.91 / $424.63	Facility		$195.98	$280.91	$424.63
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $73.56 / $83.39 / $193.69	Facility	26	$73.56	$83.39	$193.69
Medcost Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $225.65 / $395.00	Professional		$85.00	$225.65	$395.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $80.41 / $203.56 / $378.94	Facility		$80.41	$203.56	$378.94
Sentara Facility/Professional Professional Modifier Low / Median / High Price $89.50 / $255.47 / $475.68	Professional		$89.50	$255.47	$475.68
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $70.72 / $92.59 / $152.99	Professional	26	$70.72	$92.59	$152.99
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $158.41 / $204.70 / $307.92	Professional	TC	$158.41	$204.70	$307.92
United Facility/Professional Professional Modifier Low / Median / High Price $170.97 / $274.77 / $445.26	Professional		$170.97	$274.77	$445.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.04 / $85.75 / $145.47	Professional	26	$56.04	$85.75	$145.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.62 / $188.75 / $300.83	Professional	TC	$116.62	$188.75	$300.83