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 / $549.54	Facility	26	$117.49	$190.55	$549.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $426.58 / $891.25	Professional		$275.42	$426.58	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $141.25 / $309.03	Professional	26	$83.18	$141.25	$309.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $302.00 / $588.84	Professional	TC	$190.55	$302.00	$588.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $371.54 / $616.60	Professional		$269.15	$371.54	$616.60
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $109.65 / $173.78	Professional	26	$79.43	$109.65	$173.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $263.03 / $436.52	Professional	TC	$186.21	$263.03	$436.52
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $398.11 / $2,137.96	Professional		$117.49	$398.11	$2,137.96
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $104.71 / $165.96	Professional	26	$97.72	$104.71	$165.96
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $288.40 / $436.52	Professional	TC	$257.04	$288.40	$436.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $524.81 / $933.25	Professional		$251.19	$524.81	$933.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $107.15 / $190.55	Professional	26	$66.07	$107.15	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $398.11 / $741.31	Professional	TC	$181.97	$398.11	$741.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $316.23 / $407.38	Professional		$263.03	$316.23	$407.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $93.33 / $120.23	Professional	26	$75.86	$93.33	$120.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $223.87 / $295.12	Professional	TC	$186.21	$223.87	$295.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $933.25 / $954.99	Professional		$660.69	$933.25	$954.99
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $158.49 / $181.97	Professional	26	$125.89	$158.49	$181.97
Medcost Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $467.74 / $549.54	Professional		$467.74	$467.74	$549.54
Sentara Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $398.11 / $1,584.89	Professional		$109.65	$398.11	$1,584.89
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $114.82 / $190.55	Professional	26	$87.10	$114.82	$190.55
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $316.23 / $616.60	Professional	TC	$208.93	$316.23	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $446.68 / $870.96	Professional		$245.47	$446.68	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $100.00 / $177.83	Professional	26	$57.54	$100.00	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $331.13 / $758.58	Professional	TC	$177.83	$331.13	$758.58