Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.70 / $130.96 / $251.34	Professional		$103.70	$130.96	$251.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.41 / $62.44 / $137.58	Professional	26	$55.41	$62.44	$137.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.56 / $85.79 / $145.84	Professional	TC	$66.56	$85.79	$145.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.22 / $63.22 / $131.91	Professional		$63.22	$63.22	$131.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.95 / $29.95 / $62.49	Professional	26	$29.95	$29.95	$62.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.26 / $33.26 / $69.40	Professional	TC	$33.26	$33.26	$69.40
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $150.88 / $150.88 / $185.45	Professional		$150.88	$150.88	$185.45
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $59.11 / $62.53 / $83.59	Professional	26	$59.11	$62.53	$83.59
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $88.35 / $95.21 / $103.37	Professional	TC	$88.35	$95.21	$103.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.33 / $93.81 / $272.22	Professional		$69.33	$93.81	$272.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.48 / $40.81 / $132.97	Professional	26	$31.48	$40.81	$132.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.84 / $51.67 / $148.34	Professional	TC	$33.84	$51.67	$148.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $163.97 / $213.16 / $240.09	Professional		$163.97	$213.16	$240.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.95 / $84.45 / $111.00	Professional	26	$64.95	$84.45	$111.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $99.01 / $128.71 / $150.34	Professional	TC	$99.01	$128.71	$150.34
Medcost Facility/Professional Facility Modifier Low / Median / High Price $103.71 / $182.85 / $287.95	Facility		$103.71	$182.85	$287.95
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $94.00 / $130.59 / $200.52	Facility	26	$94.00	$130.59	$200.52
Medcost Facility/Professional Professional Modifier Low / Median / High Price $91.00 / $133.00 / $246.00	Professional		$91.00	$133.00	$246.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $66.69 / $105.81 / $194.37	Facility		$66.69	$105.81	$194.37
Sentara Facility/Professional Professional Modifier Low / Median / High Price $77.47 / $144.35 / $229.71	Professional		$77.47	$144.35	$229.71
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $66.61 / $74.47 / $124.12	Professional	26	$66.61	$74.47	$124.12
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $59.59 / $85.00 / $153.24	Professional	TC	$59.59	$85.00	$153.24
United Facility/Professional Professional Modifier Low / Median / High Price $93.74 / $154.07 / $258.43	Professional		$93.74	$154.07	$258.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.20 / $73.67 / $132.61	Professional	26	$44.20	$73.67	$132.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.47 / $80.61 / $129.24	Professional	TC	$44.47	$80.61	$129.24