Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $270.76 / $343.39 / $567.96	Facility	26	$270.76	$343.39	$567.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,051.78 / $1,152.61 / $1,977.34	Professional		$1,051.78	$1,152.61	$1,977.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $270.77 / $337.76 / $614.41	Professional	26	$270.77	$337.76	$614.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $779.44 / $814.86 / $1,362.79	Professional	TC	$779.44	$814.86	$1,362.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $934.30 / $1,189.52 / $1,657.96	Professional		$934.30	$1,189.52	$1,657.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $260.89 / $332.18 / $463.00	Professional	26	$260.89	$332.18	$463.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $673.38 / $857.33 / $1,194.96	Professional	TC	$673.38	$857.33	$1,194.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $1,194.46 / $2,621.75 / $15,407.28	Professional		$1,194.46	$2,621.75	$15,407.28
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $314.82 / $327.29 / $706.70	Professional	26	$314.82	$327.29	$706.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $879.64 / $914.78 / $1,783.82	Professional	TC	$879.64	$914.78	$1,783.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,038.08 / $1,381.33 / $2,668.08	Professional		$1,038.08	$1,381.33	$2,668.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $302.25 / $408.40 / $748.57	Professional	26	$302.25	$408.40	$748.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $740.96 / $979.82 / $1,919.50	Professional	TC	$740.96	$979.82	$1,919.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $942.73 / $1,131.28 / $1,403.18	Professional		$942.73	$1,131.28	$1,403.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $268.64 / $322.38 / $397.60	Professional	26	$268.64	$322.38	$397.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $674.09 / $816.98 / $1,021.23	Professional	TC	$674.09	$816.98	$1,021.23
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $469.82 / $503.25 / $511.93	Facility	26	$469.82	$503.25	$511.93
Medcost Facility/Professional Professional Modifier Low / Median / High Price $380.00 / $1,001.00 / $1,831.00	Professional		$380.00	$1,001.00	$1,831.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $368.77 / $1,197.16 / $6,073.00	Professional		$368.77	$1,197.16	$6,073.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $304.85 / $396.07 / $675.73	Professional	26	$304.85	$396.07	$675.73
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $779.26 / $943.78 / $1,815.20	Professional	TC	$779.26	$943.78	$1,815.20
United Facility/Professional Professional Modifier Low / Median / High Price $980.59 / $1,517.86 / $2,325.19	Professional		$980.59	$1,517.86	$2,325.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $258.39 / $425.85 / $612.71	Professional	26	$258.39	$425.85	$612.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $690.39 / $1,075.36 / $1,657.78	Professional	TC	$690.39	$1,075.36	$1,657.78