Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $169.73 / $289.47	Facility	26	$118.59	$169.73	$289.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.50 / $503.19 / $844.00	Professional		$370.50	$503.19	$844.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.18 / $140.00 / $182.25	Professional	26	$99.18	$140.00	$182.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $348.53 / $612.66	Professional	TC	$281.41	$348.53	$612.66
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $388.77 / $497.15 / $779.03	Professional		$388.77	$497.15	$779.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.80 / $115.23 / $178.19	Professional	26	$91.80	$115.23	$178.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $295.95 / $378.46 / $624.59	Professional	TC	$295.95	$378.46	$624.59
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $694.21 / $710.72 / $3,315.22	Professional		$694.21	$710.72	$3,315.22
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $108.98 / $116.26 / $145.33	Professional	26	$108.98	$116.26	$145.33
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $573.12 / $594.46 / $864.22	Professional	TC	$573.12	$594.46	$864.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.52 / $116.52 / $116.52	Facility	26	$116.52	$116.52	$116.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $389.14 / $801.43 / $1,339.15	Professional		$389.14	$801.43	$1,339.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.56 / $134.15 / $241.31	Professional	26	$82.56	$134.15	$241.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $303.93 / $663.53 / $1,193.19	Professional	TC	$303.93	$663.53	$1,193.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $399.29 / $479.15 / $587.19	Professional		$399.29	$479.15	$587.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.90 / $113.53 / $136.33	Professional	26	$91.90	$113.53	$136.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $307.39 / $368.86 / $452.04	Professional	TC	$307.39	$368.86	$452.04
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $153.65 / $177.00 / $318.57	Facility	26	$153.65	$177.00	$318.57
Medcost Facility/Professional Professional Modifier Low / Median / High Price $144.00 / $614.00 / $1,201.00	Professional		$144.00	$614.00	$1,201.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $146.41 / $660.36 / $1,233.70	Professional		$146.41	$660.36	$1,233.70
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $106.75 / $144.55 / $228.88	Professional	26	$106.75	$144.55	$228.88
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $373.20 / $548.83 / $867.28	Professional	TC	$373.20	$548.83	$867.28
United Facility/Professional Professional Modifier Low / Median / High Price $385.94 / $653.99 / $1,306.67	Professional		$385.94	$653.99	$1,306.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.09 / $130.97 / $198.05	Professional	26	$81.09	$130.97	$198.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $298.26 / $529.13 / $1,190.59	Professional	TC	$298.26	$529.13	$1,190.59