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 $328.93 / $475.00 / $844.00	Professional		$328.93	$475.00	$844.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.70 / $152.13 / $237.44	Professional	26	$108.70	$152.13	$237.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.58 / $335.00 / $522.21	Professional	TC	$218.58	$335.00	$522.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $303.94 / $388.68 / $642.60	Professional		$303.94	$388.68	$642.60
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 $204.98 / $262.13 / $472.00	Professional	TC	$204.98	$262.13	$472.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $526.05 / $526.50 / $3,416.74	Professional		$526.05	$526.50	$3,416.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $123.53 / $129.12 / $170.97	Professional	26	$123.53	$129.12	$170.97
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $396.95 / $402.97 / $785.79	Professional	TC	$396.95	$402.97	$785.79
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 $279.66 / $667.03 / $1,466.20	Professional		$279.66	$667.03	$1,466.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.72 / $148.06 / $268.48	Professional	26	$88.72	$148.06	$268.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $209.52 / $469.45 / $1,214.16	Professional	TC	$209.52	$469.45	$1,214.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $311.26 / $373.51 / $459.98	Professional		$311.26	$373.51	$459.98
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 $213.33 / $256.00 / $313.73	Professional	TC	$213.33	$256.00	$313.73
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $183.65 / $215.00 / $383.00	Facility	26	$183.65	$215.00	$383.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $153.00 / $468.00 / $1,061.00	Professional		$153.00	$468.00	$1,061.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $169.91 / $602.10 / $1,367.40	Professional		$169.91	$602.10	$1,367.40
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 $254.52 / $473.15 / $795.02	Professional	TC	$254.52	$473.15	$795.02
United Facility/Professional Professional Modifier Low / Median / High Price $296.97 / $540.66 / $1,375.98	Professional		$296.97	$540.66	$1,375.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.43 / $139.96 / $235.08	Professional	26	$87.43	$139.96	$235.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $203.66 / $376.38 / $1,111.34	Professional	TC	$203.66	$376.38	$1,111.34