Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.98 / $59.02 / $129.86	Professional		$47.98	$59.02	$129.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.70 / $19.80 / $52.81	Professional	26	$17.70	$19.80	$52.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.64 / $40.72 / $87.56	Professional	TC	$31.64	$40.72	$87.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.32 / $28.32 / $59.09	Professional		$28.32	$28.32	$59.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.50 / $9.50 / $19.82	Professional	26	$9.50	$9.50	$19.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.73 / $19.73 / $41.19	Professional	TC	$19.73	$19.73	$41.19
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $71.77 / $72.80 / $101.36	Professional		$71.77	$72.80	$101.36
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $23.81 / $25.05 / $36.49	Professional	26	$23.81	$25.05	$36.49
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $44.75 / $47.75 / $64.87	Professional	TC	$44.75	$47.75	$64.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.13 / $39.35 / $107.59	Professional		$30.13	$39.35	$107.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.15 / $13.39 / $41.97	Professional	26	$10.15	$13.39	$41.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.60 / $27.15 / $70.64	Professional	TC	$18.60	$27.15	$70.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.95 / $87.04 / $123.81	Professional		$66.95	$87.04	$123.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.87 / $27.13 / $35.14	Professional	26	$20.87	$27.13	$35.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.08 / $61.49 / $88.65	Professional	TC	$46.08	$61.49	$88.65
Medcost Facility/Professional Facility Modifier Low / Median / High Price $58.87 / $82.26 / $147.61	Facility		$58.87	$82.26	$147.61
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $38.00 / $50.00 / $70.00	Facility	26	$38.00	$50.00	$70.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $29.00 / $57.00 / $119.00	Professional		$29.00	$57.00	$119.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $22.62 / $50.44 / $93.74	Facility		$22.62	$50.44	$93.74
Sentara Facility/Professional Professional Modifier Low / Median / High Price $33.53 / $68.03 / $110.93	Professional		$33.53	$68.03	$110.93
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $22.22 / $26.79 / $40.33	Professional	26	$22.22	$26.79	$40.33
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $38.52 / $50.08 / $72.95	Professional	TC	$38.52	$50.08	$72.95
United Facility/Professional Professional Modifier Low / Median / High Price $37.60 / $63.16 / $124.66	Professional		$37.60	$63.16	$124.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.02 / $23.46 / $46.92	Professional	26	$14.02	$23.46	$46.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.58 / $39.70 / $75.66	Professional	TC	$23.58	$39.70	$75.66