Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.50 / $60.35 / $113.95	Facility	26	$35.50	$60.35	$113.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.63 / $275.67 / $525.02	Professional		$229.63	$275.67	$525.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.50 / $38.94 / $84.95	Professional	26	$35.50	$38.94	$84.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.87 / $237.43 / $455.44	Professional	TC	$192.87	$237.43	$455.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $235.26 / $310.01 / $435.50	Professional		$235.26	$310.01	$435.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.47 / $45.56 / $63.59	Professional	26	$35.47	$45.56	$63.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $193.77 / $264.74 / $371.90	Professional	TC	$193.77	$264.74	$371.90
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $277.16 / $541.95 / $804.10	Professional		$277.16	$541.95	$804.10
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $43.66 / $43.66 / $54.57	Professional	26	$43.66	$43.66	$54.57
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $184.96 / $246.78 / $308.48	Professional	TC	$184.96	$246.78	$308.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $207.85 / $346.99 / $553.90	Professional		$207.85	$346.99	$553.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.19 / $55.89 / $88.68	Professional	26	$32.19	$55.89	$88.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $174.53 / $288.48 / $496.25	Professional	TC	$174.53	$288.48	$496.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $260.06 / $361.86 / $372.95	Professional		$260.06	$361.86	$372.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.94 / $50.52 / $52.63	Professional	26	$38.94	$50.52	$52.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $221.12 / $311.35 / $316.58	Professional	TC	$221.12	$311.35	$316.58
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $46.72 / $61.31 / $84.00	Facility	26	$46.72	$61.31	$84.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $57.00 / $308.11 / $484.09	Professional		$57.00	$308.11	$484.09
Sentara Facility/Professional Professional Modifier Low / Median / High Price $52.53 / $318.36 / $901.00	Professional		$52.53	$318.36	$901.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $43.80 / $56.93 / $89.91	Professional	26	$43.80	$56.93	$89.91
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $213.92 / $328.29 / $574.32	Professional	TC	$213.92	$328.29	$574.32
United Facility/Professional Professional Modifier Low / Median / High Price $229.23 / $369.90 / $626.20	Professional		$229.23	$369.90	$626.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.72 / $56.42 / $88.32	Professional	26	$34.72	$56.42	$88.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.86 / $317.82 / $534.00	Professional	TC	$190.86	$317.82	$534.00