Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.75 / $110.58 / $371.98	Facility	26	$85.75	$110.58	$371.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $753.62 / $842.73 / $1,160.77	Professional		$753.62	$842.73	$1,160.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.75 / $92.61 / $128.44	Professional	26	$85.75	$92.61	$128.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $674.78 / $750.12 / $1,037.71	Professional	TC	$674.78	$750.12	$1,037.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $757.86 / $966.03 / $1,428.90	Professional		$757.86	$966.03	$1,428.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.27 / $110.24 / $163.24	Professional	26	$87.27	$110.24	$163.24
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $670.58 / $854.78 / $1,254.22	Professional	TC	$670.58	$854.78	$1,254.22
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $940.57 / $1,112.95 / $1,232.85	Professional		$940.57	$1,112.95	$1,232.85
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $113.40 / $114.81 / $143.51	Professional	26	$113.40	$114.81	$143.51
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $952.27 / $1,039.24 / $1,299.05	Professional	TC	$952.27	$1,039.24	$1,299.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $913.57 / $1,301.77 / $2,142.41	Professional		$913.57	$1,301.77	$2,142.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.31 / $135.90 / $214.21	Professional	26	$77.31	$135.90	$214.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $820.58 / $1,160.29 / $1,902.79	Professional	TC	$820.58	$1,160.29	$1,902.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $789.17 / $1,100.53 / $1,131.60	Professional		$789.17	$1,100.53	$1,131.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.61 / $121.14 / $126.19	Professional	26	$93.61	$121.14	$126.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $695.56 / $979.39 / $995.94	Professional	TC	$695.56	$979.39	$995.94
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $113.16 / $113.16 / $113.16	Facility	26	$113.16	$113.16	$113.16
Medcost Facility/Professional Professional Modifier Low / Median / High Price $145.16 / $1,274.58 / $1,714.00	Professional		$145.16	$1,274.58	$1,714.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $123.07 / $1,031.88 / $2,080.44	Professional		$123.07	$1,031.88	$2,080.44
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $104.12 / $136.40 / $217.61	Professional	26	$104.12	$136.40	$217.61
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $842.83 / $1,106.98 / $1,834.81	Professional	TC	$842.83	$1,106.98	$1,834.81
United Facility/Professional Professional Modifier Low / Median / High Price $757.74 / $1,273.30 / $1,909.73	Professional		$757.74	$1,273.30	$1,909.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.30 / $135.36 / $209.99	Professional	26	$83.30	$135.36	$209.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $672.93 / $1,175.98 / $1,796.23	Professional	TC	$672.93	$1,175.98	$1,796.23