Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $162.18 / $281.84	Facility	26	$117.49	$162.18	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $524.81 / $1,174.90	Professional		$331.13	$524.81	$1,174.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $134.90 / $257.04	Professional	26	$69.18	$134.90	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $371.54 / $812.83	Professional	TC	$257.04	$371.54	$812.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $457.09 / $758.58	Professional		$331.13	$457.09	$758.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $91.20 / $144.54	Professional	26	$67.61	$91.20	$144.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $363.08 / $616.60	Professional	TC	$257.04	$363.08	$616.60
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $501.19 / $2,951.21	Professional		$95.50	$501.19	$2,951.21
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $87.10 / $147.91	Professional	26	$81.28	$87.10	$147.91
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $398.11 / $588.84	Professional	TC	$398.11	$398.11	$588.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $724.44 / $1,318.26	Professional		$323.59	$724.44	$1,318.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $100.00 / $181.97	Professional	26	$56.23	$100.00	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $602.56 / $1,174.90	Professional	TC	$257.04	$602.56	$1,174.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $389.05 / $501.19	Professional		$323.59	$389.05	$501.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $77.62 / $97.72	Professional	26	$63.10	$77.62	$97.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $309.03 / $407.38	Professional	TC	$257.04	$309.03	$407.38
Medcost Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,412.54 / $1,445.44	Professional		$794.33	$1,412.54	$1,445.44
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $151.36 / $158.49	Professional	26	$125.89	$151.36	$158.49
Medcost Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $562.34 / $758.58	Professional		$562.34	$562.34	$758.58
Sentara Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $562.34 / $2,089.30	Professional		$104.71	$562.34	$2,089.30
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $107.15 / $169.82	Professional	26	$72.44	$107.15	$169.82
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $537.03 / $851.14	Professional	TC	$281.84	$537.03	$851.14
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $575.44 / $1,318.26	Professional		$302.00	$575.44	$1,318.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $87.10 / $151.36	Professional	26	$53.70	$87.10	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $478.63 / $1,202.26	Professional	TC	$239.88	$478.63	$1,202.26