Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $190.30 / $338.36	Facility	26	$118.59	$190.30	$338.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.24 / $486.64 / $844.00	Professional		$331.24	$486.64	$844.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.81 / $155.65 / $252.31	Professional	26	$108.81	$155.65	$252.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $219.91 / $335.00 / $500.90	Professional	TC	$219.91	$335.00	$500.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $303.32 / $387.89 / $641.29	Professional		$303.32	$387.89	$641.29
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.96 / $124.52 / $193.24	Professional	26	$98.96	$124.52	$193.24
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $204.37 / $261.35 / $472.00	Professional	TC	$204.37	$261.35	$472.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $524.88 / $525.98 / $3,418.82	Professional		$524.88	$525.98	$3,418.82
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $123.50 / $129.12 / $170.97	Professional	26	$123.50	$129.12	$170.97
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $395.76 / $402.45 / $784.78	Professional	TC	$395.76	$402.45	$784.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $299.72 / $665.75 / $1,414.32	Professional		$299.72	$665.75	$1,414.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.99 / $150.13 / $270.00	Professional	26	$89.99	$150.13	$270.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.90 / $471.60 / $1,190.84	Professional	TC	$208.90	$471.60	$1,190.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $310.61 / $372.73 / $459.04	Professional		$310.61	$372.73	$459.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $97.93 / $120.97 / $145.32	Professional	26	$97.93	$120.97	$145.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $212.68 / $255.21 / $312.76	Professional	TC	$212.68	$255.21	$312.76
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $183.65 / $249.00 / $383.00	Facility	26	$183.65	$249.00	$383.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $155.00 / $467.00 / $1,122.00	Professional		$155.00	$467.00	$1,122.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $170.67 / $619.79 / $1,368.16	Professional		$170.67	$619.79	$1,368.16
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $115.75 / $164.75 / $243.95	Professional	26	$115.75	$164.75	$243.95
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $253.81 / $471.83 / $825.39	Professional	TC	$253.81	$471.83	$825.39
United Facility/Professional Professional Modifier Low / Median / High Price $300.38 / $528.33 / $1,493.49	Professional		$300.38	$528.33	$1,493.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.41 / $136.97 / $231.55	Professional	26	$86.41	$136.97	$231.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $203.10 / $387.42 / $1,111.34	Professional	TC	$203.10	$387.42	$1,111.34