Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $169.19 / $288.58	Facility	26	$118.59	$169.19	$288.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $348.45 / $476.10 / $879.52	Professional		$348.45	$476.10	$879.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.64 / $145.65 / $220.43	Professional	26	$101.64	$145.65	$220.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $243.80 / $340.00 / $683.98	Professional	TC	$243.80	$340.00	$683.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $321.14 / $410.69 / $678.99	Professional		$321.14	$410.69	$678.99
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.42 / $114.87 / $177.60	Professional	26	$91.42	$114.87	$177.60
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $228.64 / $292.39 / $488.56	Professional	TC	$228.64	$292.39	$488.56
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $592.95 / $608.92 / $3,315.22	Professional		$592.95	$608.92	$3,315.22
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $108.59 / $115.41 / $144.26	Professional	26	$108.59	$115.41	$144.26
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $472.30 / $493.52 / $864.22	Professional	TC	$472.30	$493.52	$864.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $319.10 / $736.66 / $1,371.88	Professional		$319.10	$736.66	$1,371.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.26 / $133.71 / $240.52	Professional	26	$82.26	$133.71	$240.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.20 / $533.25 / $1,210.99	Professional	TC	$234.20	$533.25	$1,210.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $329.82 / $395.78 / $485.88	Professional		$329.82	$395.78	$485.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.57 / $113.12 / $135.84	Professional	26	$91.57	$113.12	$135.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $238.25 / $285.89 / $350.36	Professional	TC	$238.25	$285.89	$350.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $154.59 / $176.00 / $317.55	Facility	26	$154.59	$176.00	$317.55
Medcost Facility/Professional Professional Modifier Low / Median / High Price $140.44 / $512.00 / $1,182.00	Professional		$140.44	$512.00	$1,182.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $143.84 / $636.35 / $1,321.04	Professional		$143.84	$636.35	$1,321.04
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $106.94 / $144.07 / $228.11	Professional	26	$106.94	$144.07	$228.11
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $283.49 / $526.33 / $828.56	Professional	TC	$283.49	$526.33	$828.56
United Facility/Professional Professional Modifier Low / Median / High Price $313.86 / $561.45 / $1,326.17	Professional		$313.86	$561.45	$1,326.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.53 / $130.54 / $197.00	Professional	26	$80.53	$130.54	$197.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $226.84 / $431.47 / $1,243.63	Professional	TC	$226.84	$431.47	$1,243.63