Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $179.28 / $371.49	Facility	26	$118.59	$179.28	$371.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.00 / $495.98 / $920.48	Professional		$400.00	$495.98	$920.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.06 / $140.00 / $191.35	Professional	26	$107.06	$140.00	$191.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $366.66 / $694.20	Professional	TC	$281.41	$366.66	$694.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $441.93 / $569.20 / $878.02	Professional		$441.93	$569.20	$878.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $96.28 / $118.60 / $187.03	Professional	26	$96.28	$118.60	$187.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $349.73 / $447.23 / $682.92	Professional	TC	$349.73	$447.23	$682.92
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $714.05 / $783.47 / $3,315.58	Professional		$714.05	$783.47	$3,315.58
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $114.37 / $121.56 / $151.94	Professional	26	$114.37	$121.56	$151.94
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $586.96 / $661.91 / $859.43	Professional	TC	$586.96	$661.91	$859.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.33 / $122.33 / $122.33	Facility	26	$122.33	$122.33	$122.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $448.87 / $961.47 / $1,493.11	Professional		$448.87	$961.47	$1,493.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.65 / $141.41 / $252.46	Professional	26	$86.65	$141.41	$252.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $359.16 / $784.95 / $1,265.22	Professional	TC	$359.16	$784.95	$1,265.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $459.18 / $551.01 / $675.26	Professional		$459.18	$551.01	$675.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $96.40 / $119.08 / $143.53	Professional	26	$96.40	$119.08	$143.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $362.78 / $435.34 / $533.50	Professional	TC	$362.78	$435.34	$533.50
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $161.90 / $185.00 / $336.45	Facility	26	$161.90	$185.00	$336.45
Medcost Facility/Professional Professional Modifier Low / Median / High Price $148.28 / $708.36 / $1,318.00	Professional		$148.28	$708.36	$1,318.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $152.22 / $710.31 / $1,236.00	Professional		$152.22	$710.31	$1,236.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $113.69 / $151.25 / $239.49	Professional	26	$113.69	$151.25	$239.49
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $378.20 / $590.59 / $940.54	Professional	TC	$378.20	$590.59	$940.54
United Facility/Professional Professional Modifier Low / Median / High Price $446.06 / $735.99 / $1,447.56	Professional		$446.06	$735.99	$1,447.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $84.47 / $134.27 / $225.12	Professional	26	$84.47	$134.27	$225.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $352.05 / $619.92 / $1,234.80	Professional	TC	$352.05	$619.92	$1,234.80