Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.81 / $107.68 / $212.67	Facility	26	$66.81	$107.68	$212.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $403.37 / $433.43 / $929.47	Professional		$403.37	$433.43	$929.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.81 / $76.13 / $159.05	Professional	26	$66.81	$76.13	$159.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $357.77 / $359.12 / $731.85	Professional	TC	$357.77	$359.12	$731.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $390.54 / $499.27 / $700.16	Professional		$390.54	$499.27	$700.16
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.04 / $85.71 / $120.19	Professional	26	$67.04	$85.71	$120.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $323.49 / $413.56 / $579.96	Professional	TC	$323.49	$413.56	$579.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $550.74 / $1,361.92 / $2,059.02	Professional		$550.74	$1,361.92	$2,059.02
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $83.42 / $83.42 / $152.93	Professional	26	$83.42	$83.42	$152.93
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $467.32 / $467.32 / $651.34	Professional	TC	$467.32	$467.32	$651.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $381.03 / $617.91 / $1,059.40	Professional		$381.03	$617.91	$1,059.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.87 / $107.55 / $164.25	Professional	26	$60.87	$107.55	$164.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $314.20 / $506.84 / $893.77	Professional	TC	$314.20	$506.84	$893.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $415.03 / $576.23 / $595.51	Professional		$415.03	$576.23	$595.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $73.01 / $94.64 / $98.59	Professional	26	$73.01	$94.64	$98.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $342.02 / $481.58 / $489.61	Professional	TC	$342.02	$481.58	$489.61
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $112.44 / $112.44 / $113.33	Facility	26	$112.44	$112.44	$113.33
Medcost Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $541.00 / $844.39	Professional		$100.00	$541.00	$844.39
Sentara Facility/Professional Professional Modifier Low / Median / High Price $95.39 / $522.84 / $3,517.00	Professional		$95.39	$522.84	$3,517.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $76.50 / $104.72 / $168.63	Professional	26	$76.50	$104.72	$168.63
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $283.05 / $527.79 / $883.75	Professional	TC	$283.05	$527.79	$883.75
United Facility/Professional Professional Modifier Low / Median / High Price $384.32 / $642.16 / $1,069.13	Professional		$384.32	$642.16	$1,069.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.02 / $115.40 / $186.25	Professional	26	$71.02	$115.40	$186.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $330.82 / $567.24 / $906.06	Professional	TC	$330.82	$567.24	$906.06