Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $139.16 / $282.67	Facility	26	$94.15	$139.16	$282.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $393.25 / $413.66 / $835.20	Professional		$393.25	$413.66	$835.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.71 / $95.23 / $182.01	Professional	26	$90.71	$95.23	$182.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $302.52 / $318.42 / $615.39	Professional	TC	$302.52	$318.42	$615.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $376.47 / $481.43 / $722.81	Professional		$376.47	$481.43	$722.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.10 / $120.30 / $168.70	Professional	26	$94.10	$120.30	$168.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $280.27 / $352.18 / $491.57	Professional	TC	$280.27	$352.18	$491.57
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $483.28 / $483.28 / $483.28	Professional		$483.28	$483.28	$483.28
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $108.26 / $108.26 / $108.26	Professional	26	$108.26	$108.26	$108.26
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $375.02 / $375.02 / $375.02	Professional	TC	$375.02	$375.02	$375.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $119.59 / $119.59 / $119.59	Facility	26	$119.59	$119.59	$119.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $365.57 / $572.35 / $1,102.47	Professional		$365.57	$572.35	$1,102.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.41 / $139.11 / $260.63	Professional	26	$89.41	$139.11	$260.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $266.27 / $426.46 / $841.84	Professional	TC	$266.27	$426.46	$841.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $396.60 / $543.78 / $569.67	Professional		$396.60	$543.78	$569.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $103.82 / $136.13 / $141.80	Professional	26	$103.82	$136.13	$141.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $292.77 / $408.79 / $419.39	Professional	TC	$292.77	$408.79	$419.39
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $149.96 / $151.34 / $313.26	Facility	26	$149.96	$151.34	$313.26
Medcost Facility/Professional Professional Modifier Low / Median / High Price $131.00 / $501.74 / $873.00	Professional		$131.00	$501.74	$873.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $144.86 / $506.70 / $1,061.77	Professional		$144.86	$506.70	$1,061.77
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $103.83 / $155.26 / $252.65	Professional	26	$103.83	$155.26	$252.65
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $347.97 / $476.16 / $809.11	Professional	TC	$347.97	$476.16	$809.11
United Facility/Professional Professional Modifier Low / Median / High Price $365.58 / $583.57 / $844.58	Professional		$365.58	$583.57	$844.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.98 / $131.55 / $210.95	Professional	26	$86.98	$131.55	$210.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $278.60 / $417.90 / $655.24	Professional	TC	$278.60	$417.90	$655.24