Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $812.83 / $1,584.89	Facility		$218.78	$812.83	$1,584.89
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $52.48 / $134.90	Facility	26	$30.90	$52.48	$134.90
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $169.82 / $758.58 / $1,479.11	Facility	TC	$169.82	$758.58	$1,479.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $251.19 / $676.08	Professional		$169.82	$251.19	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $42.66 / $107.15	Professional	26	$30.20	$42.66	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $177.83 / $331.13	Professional	TC	$141.25	$177.83	$331.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $245.47 / $363.08	Professional		$177.83	$245.47	$363.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $43.65 / $63.10	Professional	26	$31.62	$43.65	$63.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $204.17 / $302.00	Professional	TC	$147.91	$204.17	$302.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $208.93 / $977.24	Professional		$33.88	$208.93	$977.24
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $30.20 / $40.74	Professional	26	$30.20	$30.20	$40.74
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $177.83 / $204.17	Professional	TC	$158.49	$177.83	$204.17
Cigna Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $630.96 / $1,000.00	Facility		$363.08	$630.96	$1,000.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.48 / $165.96 / $234.42	Facility	TC	$35.48	$165.96	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $275.42 / $436.52	Professional		$181.97	$275.42	$436.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $44.67 / $74.13	Professional	26	$31.62	$44.67	$74.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $229.09 / $363.08	Professional	TC	$151.36	$229.09	$363.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $213.80 / $269.15	Professional		$169.82	$213.80	$269.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $34.67 / $43.65	Professional	26	$27.54	$34.67	$43.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $177.83 / $223.87	Professional	TC	$144.54	$177.83	$223.87
Medcost Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $316.23 / $323.59	Professional		$257.04	$316.23	$323.59
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $54.95 / $61.66	Professional	26	$43.65	$54.95	$61.66
Medcost Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $263.03 / $426.58	Facility		$186.21	$263.03	$426.58
Medcost Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Professional		$151.36	$151.36	$151.36
Sentara Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $208.93 / $426.58	Facility		$38.02	$208.93	$426.58
Sentara Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $234.42 / $831.76	Professional		$42.66	$234.42	$831.76
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $44.67 / $70.79	Professional	26	$33.11	$44.67	$70.79
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $218.78 / $363.08	Professional	TC	$162.18	$218.78	$363.08
United Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $181.97 / $1,122.02	Facility		$34.67	$181.97	$1,122.02
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $251.19 / $416.87	Professional		$165.96	$251.19	$416.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $38.90 / $67.61	Professional	26	$27.54	$38.90	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $208.93 / $354.81	Professional	TC	$134.90	$208.93	$354.81