Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $101.54 / $589.69 / $1,073.33	Facility		$101.54	$589.69	$1,073.33
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.77 / $31.20 / $87.12	Facility	26	$19.77	$31.20	$87.12
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $119.38 / $680.47 / $1,012.32	Facility	TC	$119.38	$680.47	$1,012.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $108.41 / $127.70 / $218.53	Professional		$108.41	$127.70	$218.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.77 / $24.00 / $44.44	Professional	26	$19.77	$24.00	$44.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.34 / $103.70 / $180.62	Professional	TC	$91.34	$103.70	$180.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.33 / $138.57 / $194.82	Professional		$108.33	$138.57	$194.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $24.37 / $33.84	Professional	26	$19.05	$24.37	$33.84
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $89.52 / $114.08 / $160.01	Professional	TC	$89.52	$114.08	$160.01
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $125.56 / $125.56 / $539.76	Professional		$125.56	$125.56	$539.76
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $21.35 / $21.35 / $40.35	Professional	26	$21.35	$21.35	$40.35
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $104.21 / $104.21 / $196.96	Professional	TC	$104.21	$104.21	$196.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $247.14 / $386.39 / $711.77	Facility		$247.14	$386.39	$711.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.98 / $23.98 / $23.98	Facility	26	$23.98	$23.98	$23.98
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $109.98 / $109.98 / $109.98	Facility	TC	$109.98	$109.98	$109.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.67 / $172.02 / $276.63	Professional		$115.67	$172.02	$276.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.41 / $28.80 / $49.93	Professional	26	$20.41	$28.80	$49.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.11 / $141.71 / $230.48	Professional	TC	$95.11	$141.71	$230.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.57 / $141.21 / $173.88	Professional		$112.57	$141.21	$173.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.63 / $23.67 / $29.26	Professional	26	$18.63	$23.67	$29.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.79 / $118.20 / $145.63	Professional	TC	$92.79	$118.20	$145.63
Medcost Facility/Professional Facility Modifier Low / Median / High Price $120.79 / $167.65 / $262.44	Facility		$120.79	$167.65	$262.44
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $24.24 / $58.96 / $68.00	Facility	26	$24.24	$58.96	$68.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $96.91 / $168.65 / $246.95	Facility	TC	$96.91	$168.65	$246.95
Medcost Facility/Professional Professional Modifier Low / Median / High Price $29.00 / $145.00 / $245.00	Professional		$29.00	$145.00	$245.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $25.64 / $130.11 / $233.84	Facility		$25.64	$130.11	$233.84
Sentara Facility/Professional Professional Modifier Low / Median / High Price $29.48 / $152.59 / $285.91	Professional		$29.48	$152.59	$285.91
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $21.64 / $29.97 / $47.45	Professional	26	$21.64	$29.97	$47.45
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $110.50 / $146.31 / $224.96	Professional	TC	$110.50	$146.31	$224.96
United Facility/Professional Professional Modifier Low / Median / High Price $107.89 / $159.97 / $264.75	Professional		$107.89	$159.97	$264.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $26.61 / $44.92	Professional	26	$17.07	$26.61	$44.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.43 / $131.38 / $222.78	Professional	TC	$84.43	$131.38	$222.78