Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.31 / $81.22 / $221.20	Facility	26	$56.31	$81.22	$221.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $290.13 / $309.35 / $631.96	Professional		$290.13	$309.35	$631.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.31 / $60.87 / $133.81	Professional	26	$56.31	$60.87	$133.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $231.59 / $248.83 / $510.72	Professional	TC	$231.59	$248.83	$510.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $278.32 / $360.28 / $506.12	Professional		$278.32	$360.28	$506.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.82 / $72.64 / $101.87	Professional	26	$56.82	$72.64	$101.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $223.41 / $286.93 / $404.24	Professional	TC	$223.41	$286.93	$404.24
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $393.65 / $841.43 / $1,272.10	Professional		$393.65	$841.43	$1,272.10
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $71.18 / $71.18 / $117.47	Professional	26	$71.18	$71.18	$117.47
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $322.47 / $322.47 / $500.33	Professional	TC	$322.47	$322.47	$500.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $274.73 / $436.14 / $760.18	Professional		$274.73	$436.14	$760.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.56 / $88.92 / $139.93	Professional	26	$51.56	$88.92	$139.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $219.01 / $346.12 / $621.09	Professional	TC	$219.01	$346.12	$621.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $301.39 / $417.44 / $432.75	Professional		$301.39	$417.44	$432.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.88 / $80.18 / $83.53	Professional	26	$61.88	$80.18	$83.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $239.52 / $337.26 / $342.98	Professional	TC	$239.52	$337.26	$342.98
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $95.12 / $95.12 / $95.85	Facility	26	$95.12	$95.12	$95.85
Medcost Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $354.00 / $588.66	Professional		$85.00	$354.00	$588.66
Sentara Facility/Professional Professional Modifier Low / Median / High Price $79.34 / $327.97 / $755.61	Professional		$79.34	$327.97	$755.61
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $64.70 / $89.28 / $143.62	Professional	26	$64.70	$89.28	$143.62
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $146.40 / $365.18 / $611.99	Professional	TC	$146.40	$365.18	$611.99
United Facility/Professional Professional Modifier Low / Median / High Price $275.64 / $504.29 / $764.13	Professional		$275.64	$504.29	$764.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.21 / $100.56 / $158.72	Professional	26	$60.21	$100.56	$158.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $221.05 / $391.84 / $625.88	Professional	TC	$221.05	$391.84	$625.88