Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $111.42 / $198.32 / $309.77	Facility	26	$111.42	$198.32	$309.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $581.88 / $702.22 / $1,177.78	Professional		$581.88	$702.22	$1,177.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.42 / $134.63 / $256.29	Professional	26	$111.42	$134.63	$256.29
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $258.47 / $331.88 / $424.18	Professional	52	$258.47	$331.88	$424.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $465.22 / $552.50 / $950.30	Professional	TC	$465.22	$552.50	$950.30
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $572.90 / $748.71 / $1,153.76	Professional		$572.90	$748.71	$1,153.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $106.99 / $137.62 / $212.82	Professional	26	$106.99	$137.62	$212.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $455.37 / $610.60 / $940.93	Professional	TC	$455.37	$610.60	$940.93
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $766.47 / $766.47 / $2,017.15	Professional		$766.47	$766.47	$2,017.15
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $135.27 / $135.27 / $263.77	Professional	26	$135.27	$135.27	$263.77
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $631.20 / $631.20 / $1,230.83	Professional	TC	$631.20	$631.20	$1,230.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $640.59 / $976.97 / $1,453.76	Professional		$640.59	$976.97	$1,453.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.34 / $186.62 / $299.50	Professional	26	$117.34	$186.62	$299.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $520.69 / $782.84 / $1,193.48	Professional	TC	$520.69	$782.84	$1,193.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $635.82 / $751.94 / $972.43	Professional		$635.82	$751.94	$972.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $108.93 / $134.56 / $166.60	Professional	26	$108.93	$134.56	$166.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $526.78 / $619.87 / $805.83	Professional	TC	$526.78	$619.87	$805.83
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $144.49 / $238.00 / $332.97	Facility	26	$144.49	$238.00	$332.97
Medcost Facility/Professional Professional Modifier Low / Median / High Price $166.00 / $772.00 / $1,282.00	Professional		$166.00	$772.00	$1,282.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $194.09 / $830.52 / $1,485.11	Professional		$194.09	$830.52	$1,485.11
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $127.61 / $182.83 / $281.60	Professional	26	$127.61	$182.83	$281.60
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $557.05 / $774.38 / $1,195.72	Professional	TC	$557.05	$774.38	$1,195.72
United Facility/Professional Professional Modifier Low / Median / High Price $566.75 / $907.00 / $1,401.88	Professional		$566.75	$907.00	$1,401.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $106.35 / $180.74 / $275.68	Professional	26	$106.35	$180.74	$275.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $464.90 / $736.45 / $1,128.86	Professional	TC	$464.90	$736.45	$1,128.86