Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $56.23 / $147.91	Facility	26	$33.11	$56.23	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $302.00 / $562.34	Professional		$239.88	$302.00	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $43.65 / $141.25	Professional	26	$30.90	$43.65	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $269.15 / $512.86	Professional	TC	$213.80	$269.15	$512.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $389.05 / $588.84	Professional		$263.03	$389.05	$588.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $47.86 / $70.79	Professional	26	$33.88	$47.86	$70.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $338.84 / $512.86	Professional	TC	$234.42	$338.84	$512.86
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $380.19 / $794.33	Professional		$48.98	$380.19	$794.33
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $38.90 / $60.26	Professional	26	$34.67	$38.90	$60.26
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $302.00 / $457.09	Professional	TC	$269.15	$302.00	$457.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $363.08 / $616.60	Professional		$223.87	$363.08	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $51.29 / $81.28	Professional	26	$29.51	$51.29	$81.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $309.03 / $549.54	Professional	TC	$186.21	$309.03	$549.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $407.38 / $416.87	Professional		$288.40	$407.38	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $45.71 / $48.98	Professional	26	$35.48	$45.71	$48.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $354.81 / $371.54	Professional	TC	$257.04	$354.81	$371.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $281.84 / $354.81	Professional		$251.19	$281.84	$354.81
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $57.54 / $77.62	Professional	26	$54.95	$57.54	$77.62
Medcost Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $512.86 / $512.86	Professional		$512.86	$512.86	$512.86
Sentara Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $371.54 / $1,778.28	Professional		$47.86	$371.54	$1,778.28
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $51.29 / $83.18	Professional	26	$39.81	$51.29	$83.18
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $371.54 / $660.69	Professional	TC	$213.80	$371.54	$660.69
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $407.38 / $707.95	Professional		$208.93	$407.38	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $53.70 / $81.28	Professional	26	$31.62	$53.70	$81.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $363.08 / $630.96	Professional	TC	$181.97	$363.08	$630.96