Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $214.40 / $778.94 / $1,642.38	Facility		$214.40	$778.94	$1,642.38
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.75 / $52.27 / $133.44	Facility	26	$30.75	$52.27	$133.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $237.86 / $1,342.80 / $1,517.76	Facility	TC	$237.86	$1,342.80	$1,517.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.98 / $206.09 / $352.71	Professional		$175.98	$206.09	$352.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.75 / $36.76 / $68.48	Professional	26	$30.75	$36.76	$68.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.13 / $169.33 / $287.29	Professional	TC	$144.13	$169.33	$287.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $170.24 / $217.78 / $304.29	Professional		$170.24	$217.78	$304.29
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.80 / $37.92 / $52.93	Professional	26	$29.80	$37.92	$52.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $140.80 / $180.12 / $251.67	Professional	TC	$140.80	$180.12	$251.67
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $197.11 / $197.11 / $792.88	Professional		$197.11	$197.11	$792.88
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $32.72 / $32.72 / $61.84	Professional	26	$32.72	$32.72	$61.84
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $164.39 / $164.39 / $310.70	Professional	TC	$164.39	$164.39	$310.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $390.01 / $625.79 / $872.92	Facility		$390.01	$625.79	$872.92
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.51 / $37.51 / $37.51	Facility	26	$37.51	$37.51	$37.51
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $172.98 / $172.98 / $172.98	Facility	TC	$172.98	$172.98	$172.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.46 / $264.89 / $435.67	Professional		$181.46	$264.89	$435.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.73 / $44.43 / $77.58	Professional	26	$31.73	$44.43	$77.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.87 / $222.82 / $364.88	Professional	TC	$148.87	$222.82	$364.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $175.83 / $220.61 / $274.50	Professional		$175.83	$220.61	$274.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.83 / $36.63 / $45.27	Professional	26	$28.83	$36.63	$45.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $145.24 / $184.99 / $230.57	Professional	TC	$145.24	$184.99	$230.57
Medcost Facility/Professional Facility Modifier Low / Median / High Price $189.93 / $264.98 / $395.14	Facility		$189.93	$264.98	$395.14
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $35.94 / $94.50 / $104.00	Facility	26	$35.94	$94.50	$104.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $154.44 / $229.66 / $390.58	Facility	TC	$154.44	$229.66	$390.58
Medcost Facility/Professional Professional Modifier Low / Median / High Price $45.24 / $238.00 / $394.00	Professional		$45.24	$238.00	$394.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $39.58 / $210.96 / $371.15	Facility		$39.58	$210.96	$371.15
Sentara Facility/Professional Professional Modifier Low / Median / High Price $45.57 / $242.21 / $457.81	Professional		$45.57	$242.21	$457.81
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $32.97 / $45.79 / $74.73	Professional	26	$32.97	$45.79	$74.73
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $178.10 / $235.26 / $367.08	Professional	TC	$178.10	$235.26	$367.08
United Facility/Professional Professional Modifier Low / Median / High Price $159.08 / $256.14 / $418.08	Professional		$159.08	$256.14	$418.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.07 / $41.98 / $68.80	Professional	26	$28.07	$41.98	$68.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.78 / $213.77 / $343.63	Professional	TC	$130.78	$213.77	$343.63