Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.17 / $83.09 / $115.66	Facility	26	$52.17	$83.09	$115.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $296.76 / $383.49 / $656.31	Professional		$296.76	$383.49	$656.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.10 / $57.54 / $100.10	Professional	26	$49.10	$57.54	$100.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.27 / $321.52 / $550.27	Professional	TC	$251.27	$321.52	$550.27
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $323.61 / $443.39 / $698.63	Professional		$323.61	$443.39	$698.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.20 / $64.56 / $98.56	Professional	26	$50.20	$64.56	$98.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $265.06 / $380.90 / $600.16	Professional	TC	$265.06	$380.90	$600.16
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $391.99 / $391.99 / $764.38	Professional		$391.99	$391.99	$764.38
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $54.05 / $54.05 / $105.40	Professional	26	$54.05	$54.05	$105.40
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $337.94 / $337.94 / $658.98	Professional	TC	$337.94	$337.94	$658.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $247.74 / $461.95 / $849.73	Professional		$247.74	$461.95	$849.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.67 / $75.78 / $130.11	Professional	26	$53.67	$75.78	$130.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.66 / $393.13 / $736.19	Professional	TC	$165.66	$393.13	$736.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $376.76 / $443.87 / $576.23	Professional		$376.76	$443.87	$576.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.37 / $62.22 / $77.04	Professional	26	$50.37	$62.22	$77.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $325.88 / $384.00 / $499.20	Professional	TC	$325.88	$384.00	$499.20
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $56.27 / $73.00 / $146.52	Facility	26	$56.27	$73.00	$146.52
Medcost Facility/Professional Professional Modifier Low / Median / High Price $75.00 / $372.00 / $667.00	Professional		$75.00	$372.00	$667.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $74.93 / $383.72 / $765.00	Professional		$74.93	$383.72	$765.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $56.70 / $79.20 / $126.61	Professional	26	$56.70	$79.20	$126.61
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $285.39 / $443.94 / $719.36	Professional	TC	$285.39	$443.94	$719.36
United Facility/Professional Professional Modifier Low / Median / High Price $191.02 / $429.00 / $795.54	Professional		$191.02	$429.00	$795.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.47 / $73.47 / $116.52	Professional	26	$45.47	$73.47	$116.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.82 / $371.54 / $601.73	Professional	TC	$131.82	$371.54	$601.73