Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.79 / $59.16 / $110.83	Professional		$51.79	$59.16	$110.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.52 / $25.95 / $77.04	Professional	26	$19.52	$25.95	$77.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.45 / $37.61 / $72.48	Professional	TC	$31.45	$37.61	$72.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.98 / $40.98 / $92.43	Professional		$40.98	$40.98	$92.43
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.46 / $22.46 / $46.86	Professional	26	$22.46	$22.46	$46.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.52 / $18.52 / $38.64	Professional	TC	$18.52	$18.52	$38.64
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $78.41 / $79.92 / $113.73	Professional		$78.41	$79.92	$113.73
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $29.22 / $30.71 / $45.22	Professional	26	$29.22	$30.71	$45.22
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $49.19 / $49.21 / $68.50	Professional	TC	$49.19	$49.21	$68.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.48 / $46.80 / $138.50	Professional		$30.48	$46.80	$138.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.47 / $18.43 / $74.87	Professional	26	$12.47	$18.43	$74.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $24.59 / $67.45	Professional	TC	$17.57	$24.59	$67.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.79 / $84.23 / $144.04	Professional		$64.79	$84.23	$144.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.72 / $33.44 / $53.94	Professional	26	$25.72	$33.44	$53.94
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.08 / $52.16 / $83.14	Professional	TC	$39.08	$52.16	$83.14
Medcost Facility/Professional Facility Modifier Low / Median / High Price $61.90 / $105.37 / $184.36	Facility		$61.90	$105.37	$184.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $51.71 / $80.00 / $147.00	Facility	26	$51.71	$80.00	$147.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $78.47 / $78.47 / $102.47	Facility	TC	$78.47	$78.47	$102.47
Medcost Facility/Professional Professional Modifier Low / Median / High Price $36.00 / $80.00 / $168.00	Professional		$36.00	$80.00	$168.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $34.43 / $59.07 / $124.51	Facility		$34.43	$59.07	$124.51
Sentara Facility/Professional Professional Modifier Low / Median / High Price $53.94 / $92.56 / $131.97	Professional		$53.94	$92.56	$131.97
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $27.62 / $51.10 / $72.90	Professional	26	$27.62	$51.10	$72.90
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $39.29 / $46.97 / $73.20	Professional	TC	$39.29	$46.97	$73.20
United Facility/Professional Professional Modifier Low / Median / High Price $40.84 / $84.95 / $159.28	Professional		$40.84	$84.95	$159.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.26 / $36.40 / $81.61	Professional	26	$17.26	$36.40	$81.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.58 / $43.67 / $79.40	Professional	TC	$23.58	$43.67	$79.40