Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.84 / $55.82 / $104.48	Facility	26	$32.84	$55.82	$104.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.88 / $305.33 / $570.19	Professional		$251.88	$305.33	$570.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.84 / $38.67 / $109.22	Professional	26	$32.84	$38.67	$109.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.71 / $270.30 / $552.91	Professional	TC	$218.71	$270.30	$552.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $254.44 / $347.62 / $488.33	Professional		$254.44	$347.62	$488.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.77 / $41.89 / $58.75	Professional	26	$32.77	$41.89	$58.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $223.82 / $304.91 / $429.58	Professional	TC	$223.82	$304.91	$429.58
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $309.16 / $517.63 / $768.02	Professional		$309.16	$517.63	$768.02
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.70 / $40.70 / $50.88	Professional	26	$40.70	$40.70	$50.88
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $178.66 / $282.73 / $353.41	Professional	TC	$178.66	$282.73	$353.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $226.45 / $387.01 / $626.02	Professional		$226.45	$387.01	$626.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $51.19 / $82.03	Professional	26	$29.75	$51.19	$82.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $187.77 / $338.26 / $568.50	Professional	TC	$187.77	$338.26	$568.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $291.61 / $406.64 / $418.00	Professional		$291.61	$406.64	$418.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.99 / $46.72 / $48.66	Professional	26	$35.99	$46.72	$48.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $255.61 / $359.92 / $365.94	Professional	TC	$255.61	$359.92	$365.94
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $55.62 / $55.62 / $65.00	Facility	26	$55.62	$55.62	$65.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $52.00 / $379.00 / $551.00	Professional		$52.00	$379.00	$551.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $47.96 / $374.98 / $1,662.00	Professional		$47.96	$374.98	$1,662.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $39.47 / $52.47 / $83.08	Professional	26	$39.47	$52.47	$83.08
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $247.26 / $382.14 / $654.29	Professional	TC	$247.26	$382.14	$654.29
United Facility/Professional Professional Modifier Low / Median / High Price $243.83 / $416.07 / $693.60	Professional		$243.83	$416.07	$693.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.60 / $51.35 / $79.64	Professional	26	$31.60	$51.35	$79.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $180.93 / $361.18 / $614.01	Professional	TC	$180.93	$361.18	$614.01