Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $92.32 / $116.44 / $358.96	Facility	26	$92.32	$116.44	$358.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $336.68 / $397.25 / $652.36	Professional		$336.68	$397.25	$652.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $110.90 / $199.28	Professional	26	$89.13	$110.90	$199.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.12 / $288.64 / $492.70	Professional	TC	$251.12	$288.64	$492.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $359.87 / $460.20 / $696.70	Professional		$359.87	$460.20	$696.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.29 / $115.89 / $181.14	Professional	26	$92.29	$115.89	$181.14
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $265.52 / $339.55 / $519.80	Professional	TC	$265.52	$339.55	$519.80
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $545.54 / $546.03 / $3,438.15	Professional		$545.54	$546.03	$3,438.15
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $114.93 / $114.93 / $145.96	Professional	26	$114.93	$114.93	$145.96
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $411.35 / $431.10 / $547.50	Professional	TC	$411.35	$431.10	$547.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.52 / $118.52 / $118.52	Facility	26	$118.52	$118.52	$118.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $333.65 / $626.54 / $1,070.98	Professional		$333.65	$626.54	$1,070.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.87 / $136.30 / $230.65	Professional	26	$83.87	$136.30	$230.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $243.95 / $482.95 / $784.85	Professional	TC	$243.95	$482.95	$784.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $370.91 / $445.10 / $545.46	Professional		$370.91	$445.10	$545.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.35 / $115.31 / $138.49	Professional	26	$93.35	$115.31	$138.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $277.57 / $333.08 / $408.19	Professional	TC	$277.57	$333.08	$408.19
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $177.31 / $253.47 / $378.35	Facility	26	$177.31	$253.47	$378.35
Medcost Facility/Professional Professional Modifier Low / Median / High Price $139.00 / $441.00 / $768.00	Professional		$139.00	$441.00	$768.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $138.63 / $584.52 / $947.94	Professional		$138.63	$584.52	$947.94
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $103.64 / $143.41 / $229.73	Professional	26	$103.64	$143.41	$229.73
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $296.68 / $462.51 / $689.45	Professional	TC	$296.68	$462.51	$689.45
United Facility/Professional Professional Modifier Low / Median / High Price $326.39 / $530.39 / $916.68	Professional		$326.39	$530.39	$916.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.70 / $130.56 / $201.46	Professional	26	$83.70	$130.56	$201.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $237.40 / $387.75 / $730.45	Professional	TC	$237.40	$387.75	$730.45