Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.93 / $120.22 / $287.31	Facility	26	$110.93	$120.22	$287.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $357.65 / $416.73 / $710.82	Professional		$357.65	$416.73	$710.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.38 / $120.22 / $195.49	Professional	26	$103.38	$120.22	$195.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $247.37 / $273.22 / $488.31	Professional	TC	$247.37	$273.22	$488.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $333.50 / $431.51 / $591.80	Professional		$333.50	$431.51	$591.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $96.19 / $123.01 / $168.70	Professional	26	$96.19	$123.01	$168.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $238.43 / $308.51 / $423.12	Professional	TC	$238.43	$308.51	$423.12
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $447.29 / $648.76 / $1,024.79	Professional		$447.29	$648.76	$1,024.79
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $120.26 / $139.79 / $243.38	Professional	26	$120.26	$139.79	$243.38
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $327.02 / $398.43 / $693.69	Professional	TC	$327.02	$398.43	$693.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $332.54 / $442.95 / $868.01	Professional		$332.54	$442.95	$868.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.85 / $144.44 / $265.52	Professional	26	$106.85	$144.44	$265.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.15 / $300.33 / $597.34	Professional	TC	$213.15	$300.33	$597.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $324.42 / $389.30 / $480.34	Professional		$324.42	$389.30	$480.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $99.22 / $119.06 / $146.85	Professional	26	$99.22	$119.06	$146.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $225.20 / $272.97 / $341.21	Professional	TC	$225.20	$272.97	$341.21
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $143.46 / $167.04 / $218.28	Facility	26	$143.46	$167.04	$218.28
Medcost Facility/Professional Professional Modifier Low / Median / High Price $137.00 / $293.00 / $616.73	Professional		$137.00	$293.00	$616.73
Sentara Facility/Professional Professional Modifier Low / Median / High Price $130.80 / $369.26 / $899.96	Professional		$130.80	$369.26	$899.96
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $116.84 / $143.22 / $236.67	Professional	26	$116.84	$143.22	$236.67
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $201.52 / $294.16 / $586.54	Professional	TC	$201.52	$294.16	$586.54
United Facility/Professional Professional Modifier Low / Median / High Price $285.26 / $425.27 / $737.38	Professional		$285.26	$425.27	$737.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.94 / $154.16 / $234.73	Professional	26	$88.94	$154.16	$234.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $191.01 / $299.83 / $518.04	Professional	TC	$191.01	$299.83	$518.04