Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.05 / $74.84 / $146.72	Facility	26	$42.05	$74.84	$146.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $267.33 / $315.86 / $500.02	Professional		$267.33	$315.86	$500.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.05 / $45.24 / $110.46	Professional	26	$42.05	$45.24	$110.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.85 / $270.62 / $421.15	Professional	TC	$223.85	$270.62	$421.15
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $274.10 / $363.45 / $512.04	Professional		$274.10	$363.45	$512.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.38 / $54.44 / $75.98	Professional	26	$42.38	$54.44	$75.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $228.59 / $309.51 / $436.05	Professional	TC	$228.59	$309.51	$436.05
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $323.23 / $613.01 / $909.53	Professional		$323.23	$613.01	$909.53
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $51.80 / $51.80 / $64.75	Professional	26	$51.80	$51.80	$64.75
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $206.96 / $287.18 / $358.98	Professional	TC	$206.96	$287.18	$358.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $242.75 / $414.55 / $673.94	Professional		$242.75	$414.55	$673.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.49 / $66.15 / $105.06	Professional	26	$38.49	$66.15	$105.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.50 / $355.35 / $653.36	Professional	TC	$204.50	$355.35	$653.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $305.38 / $424.87 / $437.99	Professional		$305.38	$424.87	$437.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.15 / $59.86 / $62.35	Professional	26	$46.15	$59.86	$62.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $259.23 / $365.02 / $371.12	Professional	TC	$259.23	$365.02	$371.12
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $55.42 / $72.45 / $85.00	Facility	26	$55.42	$72.45	$85.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $67.00 / $418.00 / $634.87	Professional		$67.00	$418.00	$634.87
Sentara Facility/Professional Professional Modifier Low / Median / High Price $62.12 / $400.18 / $1,281.00	Professional		$62.12	$400.18	$1,281.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $51.65 / $67.30 / $106.57	Professional	26	$51.65	$67.30	$106.57
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $250.77 / $399.30 / $661.84	Professional	TC	$250.77	$399.30	$661.84
United Facility/Professional Professional Modifier Low / Median / High Price $283.55 / $425.33 / $714.64	Professional		$283.55	$425.33	$714.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.86 / $66.72 / $102.70	Professional	26	$36.86	$66.72	$102.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $242.49 / $394.05 / $645.84	Professional	TC	$242.49	$394.05	$645.84