Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.18 / $118.30 / $282.81	Facility	26	$108.18	$118.30	$282.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $339.81 / $416.94 / $736.19	Professional		$339.81	$416.94	$736.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.87 / $118.30 / $212.03	Professional	26	$105.87	$118.30	$212.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.43 / $296.79 / $524.89	Professional	TC	$229.43	$296.79	$524.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.37 / $428.76 / $588.04	Professional		$331.37	$428.76	$588.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.73 / $119.87 / $164.40	Professional	26	$93.73	$119.87	$164.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $238.74 / $308.89 / $423.65	Professional	TC	$238.74	$308.89	$423.65
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $444.40 / $653.54 / $2,315.00	Professional		$444.40	$653.54	$2,315.00
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $116.96 / $136.72 / $238.06	Professional	26	$116.96	$136.72	$238.06
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $327.45 / $405.47 / $705.96	Professional	TC	$327.45	$405.47	$705.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.21 / $443.44 / $878.79	Professional		$331.21	$443.44	$878.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.29 / $141.41 / $260.58	Professional	26	$104.29	$141.41	$260.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $215.76 / $302.11 / $613.16	Professional	TC	$215.76	$302.11	$613.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $323.13 / $387.76 / $478.23	Professional		$323.13	$387.76	$478.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $97.29 / $116.75 / $143.99	Professional	26	$97.29	$116.75	$143.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $225.84 / $273.74 / $342.18	Professional	TC	$225.84	$273.74	$342.18
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $141.88 / $164.45 / $215.11	Facility	26	$141.88	$164.45	$215.11
Medcost Facility/Professional Professional Modifier Low / Median / High Price $134.00 / $302.00 / $617.52	Professional		$134.00	$302.00	$617.52
Sentara Facility/Professional Professional Modifier Low / Median / High Price $129.69 / $367.64 / $906.60	Professional		$129.69	$367.64	$906.60
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $111.39 / $137.87 / $232.36	Professional	26	$111.39	$137.87	$232.36
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $202.70 / $303.91 / $599.37	Professional	TC	$202.70	$303.91	$599.37
United Facility/Professional Professional Modifier Low / Median / High Price $286.47 / $412.37 / $717.90	Professional		$286.47	$412.37	$717.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.44 / $142.87 / $223.86	Professional	26	$87.44	$142.87	$223.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $198.67 / $274.54 / $512.67	Professional	TC	$198.67	$274.54	$512.67