Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.71 / $98.54 / $141.44	Facility	26	$51.71	$98.54	$141.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.94 / $443.17 / $758.44	Professional		$338.94	$443.17	$758.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.42 / $63.17 / $108.10	Professional	26	$50.42	$63.17	$108.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $290.67 / $380.00 / $660.61	Professional	TC	$290.67	$380.00	$660.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.38 / $495.83 / $770.56	Professional		$380.38	$495.83	$770.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.50 / $64.87 / $99.95	Professional	26	$50.50	$64.87	$99.95
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $316.77 / $431.55 / $665.57	Professional	TC	$316.77	$431.55	$665.57
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $490.31 / $524.63 / $1,689.58	Professional		$490.31	$524.63	$1,689.58
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $62.84 / $62.84 / $122.54	Professional	26	$62.84	$62.84	$122.54
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $427.47 / $427.47 / $833.57	Professional	TC	$427.47	$427.47	$833.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $414.46 / $634.67 / $1,027.80	Professional		$414.46	$634.67	$1,027.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.65 / $91.67 / $145.10	Professional	26	$54.65	$91.67	$145.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $357.37 / $529.87 / $880.60	Professional	TC	$357.37	$529.87	$880.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $426.73 / $502.04 / $652.65	Professional		$426.73	$502.04	$652.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.58 / $62.48 / $77.34	Professional	26	$50.58	$62.48	$77.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $376.15 / $442.53 / $575.29	Professional	TC	$376.15	$442.53	$575.29
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $67.48 / $120.00 / $156.16	Facility	26	$67.48	$120.00	$156.16
Medcost Facility/Professional Professional Modifier Low / Median / High Price $77.00 / $500.08 / $758.00	Professional		$77.00	$500.08	$758.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $93.91 / $531.96 / $928.23	Professional		$93.91	$531.96	$928.23
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $62.28 / $88.69 / $137.33	Professional	26	$62.28	$88.69	$137.33
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $371.62 / $527.75 / $832.77	Professional	TC	$371.62	$527.75	$832.77
United Facility/Professional Professional Modifier Low / Median / High Price $345.11 / $608.09 / $970.69	Professional		$345.11	$608.09	$970.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.01 / $84.87 / $138.30	Professional	26	$50.01	$84.87	$138.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $286.74 / $503.75 / $826.17	Professional	TC	$286.74	$503.75	$826.17