Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.43 / $60.52 / $120.57	Facility	26	$40.43	$60.52	$120.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $373.07 / $407.18 / $675.54	Professional		$373.07	$407.18	$675.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.71 / $41.17 / $89.10	Professional	26	$36.71	$41.17	$89.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $334.67 / $366.73 / $612.13	Professional	TC	$334.67	$366.73	$612.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $353.90 / $458.11 / $643.55	Professional		$353.90	$458.11	$643.55
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.27 / $47.43 / $66.83	Professional	26	$37.27	$47.43	$66.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $317.14 / $410.54 / $576.72	Professional	TC	$317.14	$410.54	$576.72
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $403.38 / $504.23 / $707.67	Professional		$403.38	$504.23	$707.67
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $45.91 / $45.91 / $57.39	Professional	26	$45.91	$45.91	$57.39
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $322.08 / $394.79 / $446.84	Professional	TC	$322.08	$394.79	$446.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $352.22 / $594.75 / $1,016.93	Professional		$352.22	$594.75	$1,016.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.84 / $58.25 / $93.19	Professional	26	$33.84	$58.25	$93.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $312.45 / $536.09 / $923.89	Professional	TC	$312.45	$536.09	$923.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $383.60 / $535.61 / $549.89	Professional		$383.60	$535.61	$549.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.90 / $53.09 / $55.30	Professional	26	$40.90	$53.09	$55.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $342.69 / $482.52 / $490.66	Professional	TC	$342.69	$482.52	$490.66
Medcost Facility/Professional Professional Modifier Low / Median / High Price $56.00 / $567.00 / $876.00	Professional		$56.00	$567.00	$876.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $52.97 / $483.92 / $2,772.00	Professional		$52.97	$483.92	$2,772.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $41.61 / $57.58 / $94.45	Professional	26	$41.61	$57.58	$94.45
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $286.41 / $504.40 / $883.82	Professional	TC	$286.41	$504.40	$883.82
United Facility/Professional Professional Modifier Low / Median / High Price $362.46 / $600.79 / $931.54	Professional		$362.46	$600.79	$931.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.44 / $59.22 / $91.84	Professional	26	$36.44	$59.22	$91.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $326.02 / $564.37 / $922.96	Professional	TC	$326.02	$564.37	$922.96