Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.73 / $155.94 / $334.33	Facility	26	$91.73	$155.94	$334.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $293.74 / $330.97 / $576.48	Professional		$293.74	$330.97	$576.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.57 / $92.39 / $167.87	Professional	26	$89.57	$92.39	$167.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $204.16 / $230.07 / $408.45	Professional	TC	$204.16	$230.07	$408.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $317.01 / $409.37 / $570.28	Professional		$317.01	$409.37	$570.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.73 / $119.87 / $179.96	Professional	26	$93.73	$119.87	$179.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $222.47 / $287.27 / $398.85	Professional	TC	$222.47	$287.27	$398.85
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $380.28 / $380.28 / $4,087.28	Professional		$380.28	$380.28	$4,087.28
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $112.07 / $112.07 / $112.07	Professional	26	$112.07	$112.07	$112.07
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $268.20 / $268.20 / $268.20	Professional	TC	$268.20	$268.20	$268.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.54 / $116.54 / $116.54	Facility	26	$116.54	$116.54	$116.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $303.61 / $435.73 / $855.94	Professional		$303.61	$435.73	$855.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $134.94 / $253.93	Professional	26	$87.10	$134.94	$253.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.92 / $298.52 / $603.75	Professional	TC	$213.92	$298.52	$603.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $344.32 / $471.06 / $494.51	Professional		$344.32	$471.06	$494.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.53 / $133.15 / $138.69	Professional	26	$101.53	$133.15	$138.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $242.80 / $339.03 / $347.58	Professional	TC	$242.80	$339.03	$347.58
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $173.62 / $173.62 / $304.14	Facility	26	$173.62	$173.62	$304.14
Medcost Facility/Professional Professional Modifier Low / Median / High Price $127.00 / $318.00 / $580.63	Professional		$127.00	$318.00	$580.63
Sentara Facility/Professional Professional Modifier Low / Median / High Price $127.72 / $380.06 / $3,530.00	Professional		$127.72	$380.06	$3,530.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $101.04 / $146.91 / $223.96	Professional	26	$101.04	$146.91	$223.96
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $218.34 / $326.86 / $541.79	Professional	TC	$218.34	$326.86	$541.79
United Facility/Professional Professional Modifier Low / Median / High Price $272.27 / $408.41 / $637.03	Professional		$272.27	$408.41	$637.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $84.42 / $127.44 / $191.12	Professional	26	$84.42	$127.44	$191.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $187.85 / $305.25 / $473.44	Professional	TC	$187.85	$305.25	$473.44