Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $120.23 / $181.97	Facility	26	$109.65	$120.23	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $407.38 / $707.95	Professional		$323.59	$407.38	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $120.23 / $194.98	Professional	26	$100.00	$120.23	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $275.42 / $478.63	Professional	TC	$229.09	$275.42	$478.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $467.74 / $660.69	Professional		$346.74	$467.74	$660.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $131.83 / $190.55	Professional	26	$100.00	$131.83	$190.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $331.13 / $478.63	Professional	TC	$245.47	$331.13	$478.63
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $457.09 / $1,047.13	Professional		$154.88	$457.09	$1,047.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $131.83 / $162.18	Professional	26	$117.49	$131.83	$162.18
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $323.59 / $389.05	Professional	TC	$257.04	$323.59	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $416.87 / $794.33	Professional		$316.23	$416.87	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $138.04 / $245.47	Professional	26	$104.71	$138.04	$245.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $288.40 / $588.84	Professional	TC	$208.93	$288.40	$588.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $407.38 / $1,047.13	Professional		$323.59	$407.38	$1,047.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $125.89 / $316.23	Professional	26	$102.33	$125.89	$316.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $275.42 / $724.44	Professional	TC	$218.78	$275.42	$724.44
Medcost Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $467.74 / $891.25	Professional		$371.54	$467.74	$891.25
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $190.55 / $239.88	Professional	26	$144.54	$190.55	$239.88
Sentara Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $354.81 / $1,737.80	Professional		$128.82	$354.81	$1,737.80
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $141.25 / $234.42	Professional	26	$104.71	$141.25	$234.42
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $288.40 / $588.84	Professional	TC	$199.53	$288.40	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $416.87 / $724.44	Professional		$275.42	$416.87	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $138.04 / $229.09	Professional	26	$89.13	$138.04	$229.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $281.84 / $489.78	Professional	TC	$181.97	$281.84	$489.78