Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.42 / $191.20 / $298.51	Facility	26	$107.42	$191.20	$298.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $554.14 / $654.57 / $1,138.79	Professional		$554.14	$654.57	$1,138.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.42 / $129.72 / $262.27	Professional	26	$107.42	$129.72	$262.27
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $247.60 / $304.37 / $404.81	Professional	52	$247.60	$304.37	$404.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $442.08 / $524.61 / $899.26	Professional	TC	$442.08	$524.61	$899.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $548.02 / $713.70 / $1,103.65	Professional		$548.02	$713.70	$1,103.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.85 / $132.29 / $204.57	Professional	26	$102.85	$132.29	$204.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $433.19 / $583.44 / $899.08	Professional	TC	$433.19	$583.44	$899.08
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $728.79 / $728.79 / $1,845.77	Professional		$728.79	$728.79	$1,845.77
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $130.05 / $130.05 / $253.60	Professional	26	$130.05	$130.05	$253.60
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $598.74 / $598.74 / $1,167.54	Professional	TC	$598.74	$598.74	$1,167.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $600.00 / $912.55 / $1,388.15	Professional		$600.00	$912.55	$1,388.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.79 / $179.55 / $278.33	Professional	26	$112.79	$179.55	$278.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $496.73 / $732.62 / $1,138.08	Professional	TC	$496.73	$732.62	$1,138.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $607.03 / $718.06 / $928.40	Professional		$607.03	$718.06	$928.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.39 / $128.94 / $159.65	Professional	26	$104.39	$128.94	$159.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $502.58 / $591.34 / $768.74	Professional	TC	$502.58	$591.34	$768.74
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $138.91 / $259.44 / $320.76	Facility	26	$138.91	$259.44	$320.76
Medcost Facility/Professional Professional Modifier Low / Median / High Price $159.00 / $734.00 / $1,208.00	Professional		$159.00	$734.00	$1,208.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $186.36 / $777.91 / $1,422.60	Professional		$186.36	$777.91	$1,422.60
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $122.68 / $175.57 / $263.04	Professional	26	$122.68	$175.57	$263.04
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $519.79 / $730.37 / $1,142.55	Professional	TC	$519.79	$730.37	$1,142.55
United Facility/Professional Professional Modifier Low / Median / High Price $557.44 / $871.11 / $1,321.81	Professional		$557.44	$871.11	$1,321.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $102.52 / $174.17 / $262.17	Professional	26	$102.52	$174.17	$262.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $454.92 / $734.72 / $1,078.72	Professional	TC	$454.92	$734.72	$1,078.72