Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.66 / $99.26 / $321.32	Facility	26	$68.66	$99.26	$321.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.48 / $197.18 / $709.48	Professional		$170.48	$197.18	$709.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.45 / $73.42 / $257.12	Professional	26	$64.45	$73.42	$257.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.77 / $153.72 / $391.90	Professional	TC	$123.77	$153.72	$391.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $110.33 / $140.63 / $213.45	Professional		$110.33	$140.63	$213.45
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.86 / $52.10 / $78.48	Professional	26	$40.86	$52.10	$78.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.45 / $88.82 / $133.35	Professional	TC	$69.45	$88.82	$133.35
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $130.74 / $166.31 / $697.88	Professional		$130.74	$166.31	$697.88
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.81 / $58.70 / $58.70	Professional	26	$40.81	$58.70	$58.70
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $85.39 / $107.60 / $107.60	Professional	TC	$85.39	$107.60	$107.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.47 / $159.79 / $167.85	Professional		$117.47	$159.79	$167.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.53 / $58.43 / $60.86	Professional	26	$44.53	$58.43	$60.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.94 / $101.85 / $104.47	Professional	TC	$72.94	$101.85	$104.47
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $51.40 / $60.78 / $132.51	Facility	26	$51.40	$60.78	$132.51
Medcost Facility/Professional Professional Modifier Low / Median / High Price $56.00 / $121.48 / $281.00	Professional		$56.00	$121.48	$281.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $53.44 / $152.07 / $2,394.00	Professional		$53.44	$152.07	$2,394.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $43.00 / $62.01 / $98.19	Professional	26	$43.00	$62.01	$98.19
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $88.45 / $116.08 / $212.10	Professional	TC	$88.45	$116.08	$212.10
United Facility/Professional Professional Modifier Low / Median / High Price $98.83 / $168.48 / $291.04	Professional		$98.83	$168.48	$291.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.57 / $55.15 / $89.79	Professional	26	$35.57	$55.15	$89.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.91 / $108.62 / $199.46	Professional	TC	$66.91	$108.62	$199.46