Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $190.55 / $407.38	Facility	26	$117.49	$190.55	$407.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $524.81 / $1,698.24	Professional		$346.74	$524.81	$1,698.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $181.97 / $398.11	Professional	26	$100.00	$181.97	$398.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $363.08 / $870.96	Professional	TC	$245.47	$363.08	$870.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $467.74 / $776.25	Professional		$338.84	$467.74	$776.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $128.82 / $208.93	Professional	26	$93.33	$128.82	$208.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $338.84 / $562.34	Professional	TC	$239.88	$338.84	$562.34
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $501.19 / $3,311.31	Professional		$141.25	$501.19	$3,311.31
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $125.89 / $213.80	Professional	26	$117.49	$125.89	$213.80
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $331.13 / $549.54	Professional	TC	$331.13	$331.13	$549.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $660.69 / $1,348.96	Professional		$323.59	$660.69	$1,348.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $128.82 / $223.87	Professional	26	$79.43	$128.82	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $512.86 / $1,174.90	Professional	TC	$234.42	$512.86	$1,174.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $398.11 / $512.86	Professional		$331.13	$398.11	$512.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $112.20 / $144.54	Professional	26	$91.20	$112.20	$144.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $288.40 / $371.54	Professional	TC	$234.42	$288.40	$371.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,621.81 / $1,621.81	Professional		$831.76	$1,621.81	$1,621.81
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $190.55 / $218.78	Professional	26	$151.36	$190.55	$218.78
Medcost Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $575.44 / $758.58	Professional		$575.44	$575.44	$758.58
Sentara Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $549.54 / $1,621.81	Professional		$131.83	$549.54	$1,621.81
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $134.90 / $229.09	Professional	26	$104.71	$134.90	$229.09
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $501.19 / $912.01	Professional	TC	$263.03	$501.19	$912.01
United Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $588.84 / $1,318.26	Professional		$309.03	$588.84	$1,318.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $120.23 / $199.53	Professional	26	$69.18	$120.23	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $426.58 / $1,174.90	Professional	TC	$229.09	$426.58	$1,174.90