Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $154.88 / $549.54	Facility	26	$117.49	$154.88	$549.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $478.63 / $1,047.13	Professional		$331.13	$478.63	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $128.82 / $223.87	Professional	26	$85.11	$128.82	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $338.84 / $691.83	Professional	TC	$257.04	$338.84	$691.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $467.74 / $741.31	Professional		$331.13	$467.74	$741.31
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 50 Low / Median / High Price $501.19 / $691.83 / $1,096.48	Professional	50	$501.19	$691.83	$1,096.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $354.81 / $575.44	Professional	TC	$257.04	$354.81	$575.44
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $457.09 / $1,621.81	Professional		$117.49	$457.09	$1,621.81
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $131.83 / $177.83	Professional	26	$77.62	$131.83	$177.83
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $389.05 / $588.84	Professional	TC	$354.81	$389.05	$588.84
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 $316.23 / $575.44 / $1,000.00	Professional		$316.23	$575.44	$1,000.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $107.15 / $194.98	Professional	26	$66.07	$107.15	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $467.74 / $794.33	Professional	TC	$245.47	$467.74	$794.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $398.11 / $501.19	Professional		$331.13	$398.11	$501.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $95.50 / $120.23	Professional	26	$75.86	$95.50	$120.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $309.03 / $389.05	Professional	TC	$251.19	$309.03	$389.05
Medcost Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $812.83 / $831.76	Professional		$660.69	$812.83	$831.76
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $158.49 / $181.97	Professional	26	$128.82	$158.49	$181.97
Medcost Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $446.68 / $575.44	Professional		$446.68	$446.68	$575.44
Sentara Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $478.63 / $1,819.70	Professional		$109.65	$478.63	$1,819.70
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 $275.42 / $416.87 / $691.83	Professional	TC	$275.42	$416.87	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $501.19 / $870.96	Professional		$302.00	$501.19	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $100.00 / $177.83	Professional	26	$56.23	$100.00	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $389.05 / $707.95	Professional	TC	$234.42	$389.05	$707.95