Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.59 / $109.80 / $253.91	Facility	26	$64.59	$109.80	$253.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $342.85 / $398.20 / $660.41	Professional		$342.85	$398.20	$660.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.59 / $78.40 / $154.26	Professional	26	$64.59	$78.40	$154.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $274.27 / $320.41 / $533.41	Professional	TC	$274.27	$320.41	$533.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $358.37 / $458.15 / $642.49	Professional		$358.37	$458.15	$642.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.94 / $83.02 / $120.64	Professional	26	$64.94	$83.02	$120.64
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $291.19 / $374.47 / $526.05	Professional	TC	$291.19	$374.47	$526.05
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $438.49 / $692.39 / $1,027.31	Professional		$438.49	$692.39	$1,027.31
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $85.56 / $86.31 / $106.95	Professional	26	$85.56	$86.31	$106.95
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $352.93 / $352.93 / $441.16	Professional	TC	$352.93	$352.93	$441.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $305.61 / $551.44 / $985.21	Professional		$305.61	$551.44	$985.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.84 / $103.99 / $166.71	Professional	26	$58.84	$103.99	$166.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $246.84 / $438.32 / $823.85	Professional	TC	$246.84	$438.32	$823.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $383.16 / $531.47 / $549.91	Professional		$383.16	$531.47	$549.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $71.02 / $91.97 / $95.80	Professional	26	$71.02	$91.97	$95.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $312.14 / $439.50 / $446.96	Professional	TC	$312.14	$439.50	$446.96
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $113.13 / $113.13 / $114.18	Facility	26	$113.13	$113.13	$114.18
Medcost Facility/Professional Professional Modifier Low / Median / High Price $97.00 / $436.00 / $826.00	Professional		$97.00	$436.00	$826.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $77.30 / $457.70 / $1,060.70	Professional		$77.30	$457.70	$1,060.70
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $77.30 / $102.56 / $162.59	Professional	26	$77.30	$102.56	$162.59
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $346.81 / $526.13 / $878.76	Professional	TC	$346.81	$526.13	$878.76
United Facility/Professional Professional Modifier Low / Median / High Price $365.22 / $560.54 / $826.78	Professional		$365.22	$560.54	$826.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.64 / $107.38 / $158.43	Professional	26	$62.64	$107.38	$158.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $300.72 / $480.62 / $684.97	Professional	TC	$300.72	$480.62	$684.97