Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $155.65 / $242.81	Facility	26	$118.59	$155.65	$242.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $334.98 / $475.00 / $965.31	Professional		$334.98	$475.00	$965.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.90 / $126.00 / $178.06	Professional	26	$70.90	$126.00	$178.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.35 / $360.69 / $800.46	Professional	TC	$259.35	$360.69	$800.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $312.85 / $400.07 / $661.43	Professional		$312.85	$400.07	$661.43
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.92 / $81.73 / $135.13	Professional	26	$63.92	$81.73	$135.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $248.93 / $318.33 / $530.33	Professional	TC	$248.93	$318.33	$530.33
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $597.59 / $609.04 / $2,950.39	Professional		$597.59	$609.04	$2,950.39
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $80.23 / $83.40 / $112.34	Professional	26	$80.23	$83.40	$112.34
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $514.19 / $528.79 / $774.84	Professional	TC	$514.19	$528.79	$774.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $311.60 / $830.31 / $1,370.07	Professional		$311.60	$830.31	$1,370.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.13 / $100.60 / $184.60	Professional	26	$58.13	$100.60	$184.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $253.02 / $662.67 / $1,191.52	Professional	TC	$253.02	$662.67	$1,191.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $323.48 / $388.17 / $475.70	Professional		$323.48	$388.17	$475.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.63 / $77.36 / $93.72	Professional	26	$62.63	$77.36	$93.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $260.85 / $313.02 / $383.60	Professional	TC	$260.85	$313.02	$383.60
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $127.43 / $149.00 / $266.31	Facility	26	$127.43	$149.00	$266.31
Medcost Facility/Professional Professional Modifier Low / Median / High Price $114.00 / $658.65 / $1,384.00	Professional		$114.00	$658.65	$1,384.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $119.17 / $616.52 / $1,180.82	Professional		$119.17	$616.52	$1,180.82
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $77.20 / $109.77 / $165.49	Professional	26	$77.20	$109.77	$165.49
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $298.47 / $554.86 / $805.50	Professional	TC	$298.47	$554.86	$805.50
United Facility/Professional Professional Modifier Low / Median / High Price $299.38 / $560.29 / $1,297.57	Professional		$299.38	$560.29	$1,297.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.28 / $90.83 / $149.63	Professional	26	$56.28	$90.83	$149.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $238.83 / $463.50 / $1,158.90	Professional	TC	$238.83	$463.50	$1,158.90