Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.65 / $157.30 / $345.40	Facility	26	$103.65	$157.30	$345.40
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $152.32 / $185.33 / $405.60	Facility	53	$152.32	$185.33	$405.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $703.79 / $926.66 / $1,582.19	Professional		$703.79	$926.66	$1,582.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.65 / $138.30 / $308.86	Professional	26	$103.65	$138.30	$308.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $335.54 / $383.34 / $464.76	Professional	52	$335.54	$383.34	$464.76
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $134.22 / $153.34 / $185.90	Professional	53	$134.22	$153.34	$185.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $593.96 / $788.36 / $1,289.61	Professional	TC	$593.96	$788.36	$1,289.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $675.72 / $860.67 / $1,291.13	Professional		$675.72	$860.67	$1,291.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $101.41 / $129.94 / $208.23	Professional	26	$101.41	$129.94	$208.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $571.62 / $722.06 / $1,094.85	Professional	TC	$571.62	$722.06	$1,094.85
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $858.83 / $927.52 / $2,925.98	Professional		$858.83	$927.52	$2,925.98
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $120.82 / $134.46 / $214.41	Professional	26	$120.82	$134.46	$214.41
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $738.02 / $793.06 / $1,007.19	Professional	TC	$738.02	$793.06	$1,007.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $716.05 / $1,085.95 / $1,815.90	Professional		$716.05	$1,085.95	$1,815.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.98 / $199.98 / $327.26	Professional	26	$109.98	$199.98	$327.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $606.07 / $892.00 / $1,553.11	Professional	TC	$606.07	$892.00	$1,553.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $676.28 / $811.53 / $994.53	Professional		$676.28	$811.53	$994.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $99.80 / $123.28 / $148.07	Professional	26	$99.80	$123.28	$148.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $576.48 / $691.77 / $847.76	Professional	TC	$576.48	$691.77	$847.76
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $129.41 / $327.85 / $524.29	Facility	26	$129.41	$327.85	$524.29
Medcost Facility/Professional Professional Modifier Low / Median / High Price $194.00 / $1,081.00 / $1,565.00	Professional		$194.00	$1,081.00	$1,565.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $242.97 / $1,073.25 / $1,833.75	Professional		$242.97	$1,073.25	$1,833.75
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $127.90 / $217.16 / $305.38	Professional	26	$127.90	$217.16	$305.38
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $695.91 / $1,006.70 / $1,583.85	Professional	TC	$695.91	$1,006.70	$1,583.85
United Facility/Professional Professional Modifier Low / Median / High Price $723.46 / $1,151.15 / $1,735.20	Professional		$723.46	$1,151.15	$1,735.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $113.31 / $188.89 / $278.85	Professional	26	$113.31	$188.89	$278.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $594.41 / $977.67 / $1,577.09	Professional	TC	$594.41	$977.67	$1,577.09