Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.58 / $33.15 / $66.50	Facility	26	$20.58	$33.15	$66.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $202.26 / $219.87 / $409.77	Professional		$202.26	$219.87	$409.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.58 / $22.29 / $44.70	Professional	26	$20.58	$22.29	$44.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.03 / $197.59 / $369.00	Professional	TC	$181.03	$197.59	$369.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $196.32 / $250.98 / $351.96	Professional		$196.32	$250.98	$351.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.44 / $26.01 / $36.64	Professional	26	$20.44	$26.01	$36.64
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $175.88 / $224.85 / $315.32	Professional	TC	$175.88	$224.85	$315.32
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $269.42 / $540.22 / $816.74	Professional		$269.42	$540.22	$816.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $25.94 / $25.94 / $32.43	Professional	26	$25.94	$25.94	$32.43
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $243.48 / $243.48 / $304.35	Professional	TC	$243.48	$243.48	$304.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.61 / $320.60 / $542.28	Professional		$192.61	$320.60	$542.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.54 / $32.54 / $51.21	Professional	26	$18.54	$32.54	$51.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $170.83 / $287.80 / $490.88	Professional	TC	$170.83	$287.80	$490.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $210.51 / $293.89 / $301.73	Professional		$210.51	$293.89	$301.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.58 / $29.29 / $30.51	Professional	26	$22.58	$29.29	$30.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $187.93 / $264.62 / $269.02	Professional	TC	$187.93	$264.62	$269.02
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $34.20 / $34.20 / $34.61	Facility	26	$34.20	$34.20	$34.61
Medcost Facility/Professional Professional Modifier Low / Median / High Price $32.00 / $307.00 / $449.00	Professional		$32.00	$307.00	$449.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $29.26 / $277.52 / $1,685.00	Professional		$29.26	$277.52	$1,685.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $23.41 / $32.40 / $52.15	Professional	26	$23.41	$32.40	$52.15
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $213.49 / $290.39 / $478.43	Professional	TC	$213.49	$290.39	$478.43
United Facility/Professional Professional Modifier Low / Median / High Price $196.23 / $338.93 / $549.84	Professional		$196.23	$338.93	$549.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.82 / $34.29 / $50.22	Professional	26	$19.82	$34.29	$50.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $176.41 / $303.70 / $451.28	Professional	TC	$176.41	$303.70	$451.28