Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.06 / $78.42 / $156.12	Facility	26	$44.06	$78.42	$156.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $310.51 / $328.49 / $676.61	Professional		$310.51	$328.49	$676.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.06 / $47.17 / $105.17	Professional	26	$44.06	$47.17	$105.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.33 / $283.13 / $590.27	Professional	TC	$263.33	$283.13	$590.27
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $292.63 / $397.26 / $561.64	Professional		$292.63	$397.26	$561.64
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.49 / $57.02 / $79.76	Professional	26	$44.49	$57.02	$79.76
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $251.06 / $340.83 / $481.86	Professional	TC	$251.06	$340.83	$481.86
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $376.89 / $790.47 / $1,195.07	Professional		$376.89	$790.47	$1,195.07
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $53.89 / $53.89 / $67.36	Professional	26	$53.89	$53.89	$67.36
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $283.99 / $323.00 / $403.75	Professional	TC	$283.99	$323.00	$403.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $287.55 / $461.32 / $738.90	Professional		$287.55	$461.32	$738.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.34 / $70.19 / $110.06	Professional	26	$40.34	$70.19	$110.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $238.76 / $394.80 / $646.32	Professional	TC	$238.76	$394.80	$646.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $332.99 / $463.38 / $477.73	Professional		$332.99	$463.38	$477.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.44 / $62.72 / $65.34	Professional	26	$48.44	$62.72	$65.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $284.55 / $400.64 / $407.50	Professional	TC	$284.55	$400.64	$407.50
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $58.24 / $77.13 / $91.00	Facility	26	$58.24	$77.13	$91.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $70.00 / $426.00 / $636.00	Professional		$70.00	$426.00	$636.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $64.73 / $410.77 / $2,213.00	Professional		$64.73	$410.77	$2,213.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $55.94 / $71.30 / $111.13	Professional	26	$55.94	$71.30	$111.13
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $287.68 / $442.56 / $747.91	Professional	TC	$287.68	$442.56	$747.91
United Facility/Professional Professional Modifier Low / Median / High Price $318.19 / $483.20 / $824.71	Professional		$318.19	$483.20	$824.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.78 / $69.36 / $107.15	Professional	26	$42.78	$69.36	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $275.33 / $413.11 / $628.51	Professional	TC	$275.33	$413.11	$628.51