Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.60 / $341.32 / $1,153.07	Professional		$269.60	$341.32	$1,153.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.84 / $56.73 / $178.30	Professional	26	$38.84	$56.73	$178.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.13 / $285.63 / $849.46	Professional	TC	$245.13	$285.63	$849.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $167.04 / $167.04 / $348.57	Professional		$167.04	$167.04	$348.57
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.78 / $26.78 / $55.88	Professional	26	$26.78	$26.78	$55.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $140.26 / $140.26 / $292.69	Professional	TC	$140.26	$140.26	$292.69
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $392.69 / $392.69 / $494.77	Professional		$392.69	$392.69	$494.77
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $69.93 / $69.93 / $92.28	Professional	26	$69.93	$69.93	$92.28
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $322.76 / $322.76 / $402.49	Professional	TC	$322.76	$322.76	$402.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.40 / $239.19 / $655.86	Professional		$105.40	$239.19	$655.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.69 / $36.29 / $109.91	Professional	26	$28.69	$36.29	$109.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.81 / $182.98 / $552.36	Professional	TC	$72.81	$182.98	$552.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $370.69 / $481.90 / $552.84	Professional		$370.69	$481.90	$552.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $72.58 / $84.36	Professional	26	$60.26	$72.58	$84.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $310.43 / $403.56 / $470.36	Professional	TC	$310.43	$403.56	$470.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $96.45 / $96.45 / $183.98	Facility	26	$96.45	$96.45	$183.98
Medcost Facility/Professional Professional Modifier Low / Median / High Price $82.00 / $423.00 / $786.36	Professional		$82.00	$423.00	$786.36
Sentara Facility/Professional Professional Modifier Low / Median / High Price $90.41 / $276.31 / $759.07	Professional		$90.41	$276.31	$759.07
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $74.89 / $92.27 / $140.08	Professional	26	$74.89	$92.27	$140.08
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $36.97 / $341.05 / $792.57	Professional	TC	$36.97	$341.05	$792.57
United Facility/Professional Professional Modifier Low / Median / High Price $163.38 / $304.89 / $658.85	Professional		$163.38	$304.89	$658.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.36 / $67.27 / $124.88	Professional	26	$40.36	$67.27	$124.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.88 / $218.37 / $550.04	Professional	TC	$117.88	$218.37	$550.04