Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $319.20 / $390.82 / $769.50	Professional		$319.20	$390.82	$769.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.22 / $129.69 / $568.10	Professional	26	$75.22	$129.69	$568.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $211.76 / $272.45 / $510.07	Professional	TC	$211.76	$272.45	$510.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $408.28 / $408.28 / $851.99	Professional		$408.28	$408.28	$851.99
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $141.71 / $141.71 / $295.72	Professional	26	$141.71	$141.71	$295.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $254.58 / $254.58 / $531.25	Professional	TC	$254.58	$254.58	$531.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $436.56 / $436.56 / $510.78	Professional		$436.56	$436.56	$510.78
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $161.26 / $161.26 / $218.25	Professional	26	$161.26	$161.26	$218.25
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $275.30 / $275.30 / $322.10	Professional	TC	$275.30	$275.30	$322.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $153.63 / $260.55 / $721.17	Professional		$153.63	$260.55	$721.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.36 / $85.57 / $273.19	Professional	26	$63.36	$85.57	$273.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.76 / $166.76 / $489.82	Professional	TC	$82.76	$166.76	$489.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $409.72 / $532.64 / $616.89	Professional		$409.72	$532.64	$616.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $134.38 / $174.69 / $227.97	Professional	26	$134.38	$174.69	$227.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $275.33 / $367.26 / $417.34	Professional	TC	$275.33	$367.26	$417.34
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $145.00 / $273.26 / $413.47	Facility	26	$145.00	$273.26	$413.47
Medcost Facility/Professional Professional Modifier Low / Median / High Price $190.00 / $351.00 / $761.00	Professional		$190.00	$351.00	$761.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $175.45 / $424.39 / $826.35	Professional		$175.45	$424.39	$826.35
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $143.93 / $205.72 / $318.58	Professional	26	$143.93	$205.72	$318.58
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $213.13 / $400.55 / $637.74	Professional	TC	$213.13	$400.55	$637.74
United Facility/Professional Professional Modifier Low / Median / High Price $182.34 / $410.85 / $684.26	Professional		$182.34	$410.85	$684.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.59 / $152.04 / $245.36	Professional	26	$83.59	$152.04	$245.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.75 / $263.39 / $448.84	Professional	TC	$98.75	$263.39	$448.84