Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $132.30 / $174.93	Facility	26	$79.09	$132.30	$174.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $339.18 / $426.60 / $740.75	Professional		$339.18	$426.60	$740.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.47 / $90.76 / $158.11	Professional	26	$75.47	$90.76	$158.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $267.24 / $333.47 / $592.40	Professional	TC	$267.24	$333.47	$592.40
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $372.31 / $497.64 / $784.11	Professional		$372.31	$497.64	$784.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $73.77 / $97.31 / $162.47	Professional	26	$73.77	$97.31	$162.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $285.92 / $403.35 / $635.54	Professional	TC	$285.92	$403.35	$635.54
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $487.32 / $487.32 / $950.27	Professional		$487.32	$487.32	$950.27
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $85.91 / $85.91 / $167.52	Professional	26	$85.91	$85.91	$167.52
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $401.41 / $401.41 / $782.75	Professional	TC	$401.41	$401.41	$782.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.52 / $545.24 / $948.15	Professional		$302.52	$545.24	$948.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.12 / $119.02 / $197.91	Professional	26	$81.12	$119.02	$197.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $219.33 / $441.56 / $776.04	Professional	TC	$219.33	$441.56	$776.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $429.45 / $507.86 / $656.80	Professional		$429.45	$507.86	$656.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.17 / $94.09 / $116.49	Professional	26	$76.17	$94.09	$116.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $352.68 / $415.61 / $540.29	Professional	TC	$352.68	$415.61	$540.29
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $89.91 / $115.00 / $222.33	Facility	26	$89.91	$115.00	$222.33
Medcost Facility/Professional Professional Modifier Low / Median / High Price $115.96 / $400.00 / $752.55	Professional		$115.96	$400.00	$752.55
Sentara Facility/Professional Professional Modifier Low / Median / High Price $118.36 / $489.80 / $888.77	Professional		$118.36	$489.80	$888.77
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $87.82 / $121.72 / $193.17	Professional	26	$87.82	$121.72	$193.17
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $328.21 / $488.02 / $752.46	Professional	TC	$328.21	$488.02	$752.46
United Facility/Professional Professional Modifier Low / Median / High Price $268.58 / $459.17 / $798.37	Professional		$268.58	$459.17	$798.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.45 / $115.53 / $176.87	Professional	26	$71.45	$115.53	$176.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $198.53 / $356.26 / $630.57	Professional	TC	$198.53	$356.26	$630.57