Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $228.88 / $608.26 / $1,271.11	Facility		$228.88	$608.26	$1,271.11
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.44 / $44.11 / $152.50	Facility	26	$34.44	$44.11	$152.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $225.93 / $781.57 / $1,455.93	Facility	TC	$225.93	$781.57	$1,455.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $189.31 / $270.63 / $422.19	Professional		$189.31	$270.63	$422.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.05 / $42.01 / $71.40	Professional	26	$30.05	$42.01	$71.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.35 / $228.62 / $358.39	Professional	TC	$162.35	$228.62	$358.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.70 / $278.41 / $391.07	Professional		$213.70	$278.41	$391.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.31 / $42.86 / $60.20	Professional	26	$32.31	$42.86	$60.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $179.98 / $235.55 / $330.87	Professional	TC	$179.98	$235.55	$330.87
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $203.33 / $225.92 / $971.96	Professional		$203.33	$225.92	$971.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.40 / $32.26 / $60.97	Professional	26	$30.40	$32.26	$60.97
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $174.25 / $184.79 / $349.25	Professional	TC	$174.25	$184.79	$349.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $500.00 / $804.22 / $1,167.69	Facility		$500.00	$804.22	$1,167.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.91 / $42.91 / $42.91	Facility	26	$42.91	$42.91	$42.91
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $227.42 / $227.42 / $227.42	Facility	TC	$227.42	$227.42	$227.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $222.18 / $335.77 / $566.94	Professional		$222.18	$335.77	$566.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.96 / $44.37 / $87.93	Professional	26	$32.96	$44.37	$87.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $193.36 / $291.52 / $479.01	Professional	TC	$193.36	$291.52	$479.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $225.07 / $282.88 / $350.38	Professional		$225.07	$282.88	$350.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.04 / $41.98 / $51.84	Professional	26	$33.04	$41.98	$51.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.04 / $242.07 / $301.16	Professional	TC	$190.04	$242.07	$301.16
Medcost Facility/Professional Facility Modifier Low / Median / High Price $221.68 / $333.33 / $495.27	Facility		$221.68	$333.33	$495.27
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $30.48 / $49.00 / $105.72	Facility	26	$30.48	$49.00	$105.72
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $154.44 / $312.87 / $691.94	Facility	TC	$154.44	$312.87	$691.94
Medcost Facility/Professional Professional Modifier Low / Median / High Price $47.00 / $319.00 / $484.00	Professional		$47.00	$319.00	$484.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $37.89 / $254.43 / $483.03	Facility		$37.89	$254.43	$483.03
Sentara Facility/Professional Professional Modifier Low / Median / High Price $41.97 / $289.10 / $595.73	Professional		$41.97	$289.10	$595.73
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $28.07 / $48.08 / $83.01	Professional	26	$28.07	$48.08	$83.01
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $203.20 / $288.33 / $479.17	Professional	TC	$203.20	$288.33	$479.17
United Facility/Professional Professional Modifier Low / Median / High Price $207.01 / $330.14 / $516.85	Professional		$207.01	$330.14	$516.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.43 / $41.02 / $78.37	Professional	26	$25.43	$41.02	$78.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $178.06 / $283.38 / $454.92	Professional	TC	$178.06	$283.38	$454.92