Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $269.15 / $416.87 / $562.34	Facility	26	$269.15	$416.87	$562.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,148.15 / $2,041.74	Professional		$1,000.00	$1,148.15	$2,041.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $338.84 / $645.65	Professional	26	$269.15	$338.84	$645.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $707.95 / $812.83 / $1,318.26	Professional	TC	$707.95	$812.83	$1,318.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,288.25 / $1,819.70	Professional		$954.99	$1,288.25	$1,819.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $275.42 / $371.54 / $512.86	Professional	26	$275.42	$371.54	$512.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $933.25 / $1,288.25	Professional	TC	$691.83	$933.25	$1,288.25
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $1,819.70 / $19,498.45	Professional		$380.19	$1,819.70	$19,498.45
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $281.84 / $354.81 / $426.58	Professional	26	$281.84	$354.81	$426.58
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $870.96 / $1,000.00 / $1,174.90	Professional	TC	$870.96	$1,000.00	$1,174.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,412.54 / $2,630.27	Professional		$1,047.13	$1,412.54	$2,630.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $302.00 / $407.38 / $741.31	Professional	26	$302.00	$407.38	$741.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $741.31 / $1,000.00 / $1,862.09	Professional	TC	$741.31	$1,000.00	$1,862.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,174.90 / $1,445.44	Professional		$977.24	$1,174.90	$1,445.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $275.42 / $331.13 / $407.38	Professional	26	$275.42	$331.13	$407.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $707.95 / $851.14 / $1,071.52	Professional	TC	$707.95	$851.14	$1,071.52
Medcost Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,659.59 / $2,137.96	Professional		$1,348.96	$1,659.59	$2,137.96
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $549.54 / $549.54	Professional	26	$436.52	$549.54	$549.54
Sentara Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $1,174.90 / $11,748.98	Professional		$363.08	$1,174.90	$11,748.98
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $302.00 / $389.05 / $676.08	Professional	26	$302.00	$389.05	$676.08
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $933.25 / $1,819.70	Professional	TC	$724.44	$933.25	$1,819.70
United Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,513.56 / $2,344.23	Professional		$933.25	$1,513.56	$2,344.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $257.04 / $426.58 / $645.65	Professional	26	$257.04	$426.58	$645.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $1,096.48 / $1,698.24	Professional	TC	$691.83	$1,096.48	$1,698.24