Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.17 / $138.38 / $3,566.00	Facility	26	$97.17	$138.38	$3,566.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $304.68 / $360.87 / $582.21	Professional		$304.68	$360.87	$582.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.73 / $103.81 / $170.45	Professional	26	$93.73	$103.81	$170.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.01 / $257.07 / $373.24	Professional	TC	$214.01	$257.07	$373.24
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $321.05 / $415.40 / $665.27	Professional		$321.05	$415.40	$665.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.10 / $126.53 / $190.65	Professional	26	$98.10	$126.53	$190.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $225.57 / $288.45 / $462.63	Professional	TC	$225.57	$288.45	$462.63
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $595.46 / $693.59 / $2,784.18	Professional		$595.46	$693.59	$2,784.18
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $123.89 / $123.89 / $154.86	Professional	26	$123.89	$123.89	$154.86
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $465.95 / $569.70 / $797.58	Professional	TC	$465.95	$569.70	$797.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.62 / $124.62 / $124.62	Facility	26	$124.62	$124.62	$124.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $322.83 / $521.59 / $924.46	Professional		$322.83	$521.59	$924.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.30 / $143.44 / $242.73	Professional	26	$88.30	$143.44	$242.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $226.82 / $364.02 / $656.44	Professional	TC	$226.82	$364.02	$656.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $332.53 / $399.03 / $489.01	Professional		$332.53	$399.03	$489.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $98.22 / $117.86 / $145.75	Professional	26	$98.22	$117.86	$145.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $234.31 / $281.17 / $344.58	Professional	TC	$234.31	$281.17	$344.58
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $170.98 / $210.88 / $337.89	Facility	26	$170.98	$210.88	$337.89
Medcost Facility/Professional Professional Modifier Low / Median / High Price $191.00 / $448.00 / $725.00	Professional		$191.00	$448.00	$725.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $152.66 / $468.33 / $775.13	Professional		$152.66	$468.33	$775.13
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $116.64 / $152.80 / $244.71	Professional	26	$116.64	$152.80	$244.71
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $286.47 / $378.39 / $602.53	Professional	TC	$286.47	$378.39	$602.53
United Facility/Professional Professional Modifier Low / Median / High Price $320.43 / $598.85 / $1,343.64	Professional		$320.43	$598.85	$1,343.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.84 / $116.99 / $200.86	Professional	26	$69.84	$116.99	$200.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $226.84 / $431.47 / $1,136.46	Professional	TC	$226.84	$431.47	$1,136.46