Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.52 / $74.28 / $158.63	Facility	26	$49.52	$74.28	$158.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $299.52 / $325.08 / $442.24	Professional		$299.52	$325.08	$442.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.03 / $53.20 / $81.31	Professional	26	$49.03	$53.20	$81.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $248.77 / $271.88 / $371.74	Professional	TC	$248.77	$271.88	$371.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $288.91 / $370.26 / $517.97	Professional		$288.91	$370.26	$517.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.61 / $63.42 / $88.94	Professional	26	$49.61	$63.42	$88.94
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $239.31 / $305.94 / $429.04	Professional	TC	$239.31	$305.94	$429.04
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $399.16 / $692.39 / $1,027.31	Professional		$399.16	$692.39	$1,027.31
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $61.47 / $61.47 / $76.84	Professional	26	$61.47	$61.47	$76.84
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $337.69 / $337.69 / $422.11	Professional	TC	$337.69	$337.69	$422.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.87 / $477.58 / $791.35	Professional		$281.87	$477.58	$791.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.02 / $77.66 / $122.29	Professional	26	$45.02	$77.66	$122.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $232.44 / $401.73 / $667.64	Professional	TC	$232.44	$401.73	$667.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.30 / $429.48 / $443.79	Professional		$309.30	$429.48	$443.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.00 / $70.01 / $72.93	Professional	26	$54.00	$70.01	$72.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $255.30 / $359.47 / $365.57	Professional	TC	$255.30	$359.47	$365.57
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $81.39 / $81.39 / $82.29	Facility	26	$81.39	$81.39	$82.29
Medcost Facility/Professional Professional Modifier Low / Median / High Price $74.00 / $431.98 / $657.00	Professional		$74.00	$431.98	$657.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $69.30 / $390.28 / $783.65	Professional		$69.30	$390.28	$783.65
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $55.62 / $76.95 / $124.68	Professional	26	$55.62	$76.95	$124.68
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $297.92 / $399.58 / $657.31	Professional	TC	$297.92	$399.58	$657.31
United Facility/Professional Professional Modifier Low / Median / High Price $289.61 / $483.45 / $747.46	Professional		$289.61	$483.45	$747.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.68 / $77.48 / $120.56	Professional	26	$47.68	$77.48	$120.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $241.93 / $418.39 / $644.32	Professional	TC	$241.93	$418.39	$644.32