Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.59 / $169.19 / $309.80	Facility	26	$118.59	$169.19	$309.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.50 / $475.50 / $833.26	Professional		$370.50	$475.50	$833.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.29 / $140.00 / $182.81	Professional	26	$102.29	$140.00	$182.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $269.80 / $348.53 / $568.59	Professional	TC	$269.80	$348.53	$568.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $367.25 / $469.64 / $763.56	Professional		$367.25	$469.64	$763.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.63 / $113.54 / $178.78	Professional	26	$91.63	$113.54	$178.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $274.13 / $350.56 / $579.58	Professional	TC	$274.13	$350.56	$579.58
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $652.39 / $666.83 / $3,315.22	Professional		$652.39	$666.83	$3,315.22
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $109.38 / $116.26 / $145.33	Professional	26	$109.38	$116.26	$145.33
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $530.87 / $550.57 / $864.22	Professional	TC	$530.87	$550.57	$864.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.87 / $116.87 / $116.87	Facility	26	$116.87	$116.87	$116.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $366.93 / $808.04 / $1,412.68	Professional		$366.93	$808.04	$1,412.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.86 / $134.59 / $241.31	Professional	26	$82.86	$134.59	$241.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $619.63 / $1,216.15	Professional	TC	$281.41	$619.63	$1,216.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $375.37 / $450.44 / $552.01	Professional		$375.37	$450.44	$552.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.90 / $113.53 / $136.84	Professional	26	$91.90	$113.53	$136.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $283.48 / $340.17 / $416.88	Professional	TC	$283.48	$340.17	$416.88
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $154.59 / $177.00 / $317.55	Facility	26	$154.59	$177.00	$317.55
Medcost Facility/Professional Professional Modifier Low / Median / High Price $141.37 / $578.00 / $1,126.00	Professional		$141.37	$578.00	$1,126.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $143.84 / $669.39 / $1,321.04	Professional		$143.84	$669.39	$1,321.04
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $106.98 / $145.01 / $229.62	Professional	26	$106.98	$145.01	$229.62
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $346.05 / $602.42 / $847.21	Professional	TC	$346.05	$602.42	$847.21
United Facility/Professional Professional Modifier Low / Median / High Price $364.22 / $601.36 / $1,365.84	Professional		$364.22	$601.36	$1,365.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.34 / $128.36 / $197.48	Professional	26	$79.34	$128.36	$197.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $276.91 / $478.67 / $1,114.05	Professional	TC	$276.91	$478.67	$1,114.05