Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.98 / $121.11 / $220.28	Facility	26	$73.98	$121.11	$220.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $438.98 / $481.65 / $924.59	Professional		$438.98	$481.65	$924.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.73 / $78.56 / $146.47	Professional	26	$67.73	$78.56	$146.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $364.99 / $413.91 / $778.11	Professional	TC	$364.99	$413.91	$778.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $412.73 / $521.36 / $760.85	Professional		$412.73	$521.36	$760.85
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.29 / $95.98 / $144.56	Professional	26	$75.29	$95.98	$144.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $337.44 / $427.74 / $600.23	Professional	TC	$337.44	$427.74	$600.23
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $630.47 / $630.47 / $1,269.72	Professional		$630.47	$630.47	$1,269.72
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $83.27 / $83.27 / $83.29	Professional	26	$83.27	$83.27	$83.29
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $281.88 / $547.20 / $547.20	Professional	TC	$281.88	$547.20	$547.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.59 / $93.59 / $93.59	Facility	26	$93.59	$93.59	$93.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.82 / $594.10 / $1,177.50	Professional		$354.82	$594.10	$1,177.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.01 / $107.68 / $204.79	Professional	26	$71.01	$107.68	$204.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $286.85 / $485.22 / $979.05	Professional	TC	$286.85	$485.22	$979.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $434.14 / $603.41 / $3,600.00	Professional		$434.14	$603.41	$3,600.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.22 / $106.51 / $3,600.00	Professional	26	$81.22	$106.51	$3,600.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $352.92 / $496.90 / $3,600.00	Professional	TC	$352.92	$496.90	$3,600.00
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $95.65 / $151.00 / $244.20	Facility	26	$95.65	$151.00	$244.20
Medcost Facility/Professional Professional Modifier Low / Median / High Price $105.79 / $628.00 / $862.61	Professional		$105.79	$628.00	$862.61
Sentara Facility/Professional Professional Modifier Low / Median / High Price $105.84 / $581.01 / $1,914.00	Professional		$105.84	$581.01	$1,914.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $82.34 / $116.40 / $178.44	Professional	26	$82.34	$116.40	$178.44
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $353.56 / $578.82 / $973.71	Professional	TC	$353.56	$578.82	$973.71
United Facility/Professional Professional Modifier Low / Median / High Price $387.07 / $604.58 / $1,037.80	Professional		$387.07	$604.58	$1,037.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.29 / $101.66 / $147.62	Professional	26	$67.29	$101.66	$147.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $300.64 / $457.98 / $758.99	Professional	TC	$300.64	$457.98	$758.99