Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.25 / $57.68 / $158.65	Facility	26	$40.25	$57.68	$158.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.22 / $208.65 / $387.18	Professional		$194.22	$208.65	$387.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.25 / $43.64 / $79.84	Professional	26	$40.25	$43.64	$79.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.68 / $165.23 / $308.82	Professional	TC	$152.68	$165.23	$308.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $189.70 / $243.66 / $340.10	Professional		$189.70	$243.66	$340.10
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.59 / $52.13 / $72.77	Professional	26	$40.59	$52.13	$72.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $149.12 / $191.53 / $267.33	Professional	TC	$149.12	$191.53	$267.33
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $257.70 / $672.48 / $1,016.68	Professional		$257.70	$672.48	$1,016.68
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $49.99 / $49.99 / $62.49	Professional	26	$49.99	$49.99	$62.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $207.72 / $207.72 / $259.64	Professional	TC	$207.72	$207.72	$259.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.99 / $309.61 / $511.66	Professional		$165.99	$309.61	$511.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.85 / $63.81 / $100.55	Professional	26	$36.85	$63.81	$100.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.85 / $246.30 / $412.77	Professional	TC	$144.85	$246.30	$412.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $203.19 / $281.20 / $291.56	Professional		$203.19	$281.20	$291.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.18 / $57.29 / $59.68	Professional	26	$44.18	$57.29	$59.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $159.01 / $223.90 / $227.56	Professional	TC	$159.01	$223.90	$227.56
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $71.56 / $71.56 / $82.00	Facility	26	$71.56	$71.56	$82.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $276.00 / $421.00	Professional		$65.00	$276.00	$421.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $59.50 / $273.88 / $1,235.00	Professional		$59.50	$273.88	$1,235.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $50.13 / $65.17 / $102.02	Professional	26	$50.13	$65.17	$102.02
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $199.42 / $263.20 / $426.88	Professional	TC	$199.42	$263.20	$426.88
United Facility/Professional Professional Modifier Low / Median / High Price $186.31 / $307.41 / $496.20	Professional		$186.31	$307.41	$496.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.33 / $63.91 / $99.12	Professional	26	$39.33	$63.91	$99.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $146.97 / $253.93 / $399.44	Professional	TC	$146.97	$253.93	$399.44